Diagnosis of tricuspid stenosis by M-mode and two-dimensional echocardiography

A decreased diastolic slope (EF slope) of the tricuspid valve on the M-mode echocardiogram may not indicate the presence of tricuspid stenosis (TS). To explore diagnostic echocardiographic signs of TS, we examined an M-mode and 2-dimensional (2-D) echocardiogram in 9 patients with documented TS of rheumatic origin and in 14 patients with rheumatic heart disease who showed a decreased EF slope (less than 40 mm/s) but did not have TS. By M-mode echocardiography, the EF slope was not different between patients with TS (24.4 +/- 2.2 mm/s) and those without TS (27.4 +/- 2.0 mm/s). The early diastolic excursion (DE amplitude) of the tricuspid valve was significantly lower (p less than 0.001) in patients with TS (7.6 +/- 1.0 mm) than in patients without TS (13.9 +/- 0.6 mm). Two-dimensional echocardiograms of the tricuspid valve revealed diastolic doming in all patients with TS. Diastolic doming of the tricuspid valve was detected most often (all of 7 patients) in the apical 4-chamber view. In contrast, no patients without TS who had a decreased EF slope on the M-mode echocardiogram showed diastolic doming. These data suggest that a reduced DE amplitude of less than or equal to 10 mm associated with a decreased EF slope on the M-mode echocardiogram and diastolic doming of the tricuspid valve on the 2-D echocardiogram are useful echocardiographic signs in the diagnosis of TS.