[Doppler echocardiographic diagnosis and evaluation of tricuspid regurgitation]

The reliability of pulsed Doppler echocardiography in the diagnosis and quantification of tricuspid regurgitation was assessed by analysis of blood flow in the inferior vena cava in 28 patients. The inferior vena caval flow was sampled in the retrohepatic portion of the vessel from the subxiphoid region. Recordings from 10 normal patients were used to define criteria of normality. This was characterised by two anterograde components (one systolic and one diastolic); atrial contraction gave rise to an end diastolic retrograde component. In tricuspid incompetence, retrograde systolic blood flow was recorded. A Doppler index was calculated from the ratio of the maximal amplitude of systolic reflux to the maximal amplitude of anterograde diastolic flow. In the absence of tricuspid regurgitation, this index approximated 0. The average of this ratio over 10 consecutive beats was compared with the semi quantitative assessment of tricuspid regurgitation from selective right ventricular angiography. There were no false positive results, specificity was, therefore, 100 p. 100. Six minimal regurgitations were not detected: sensitivity was therefore 74 p. 100. All moderate and severe regurgitations were detected, and the sensitivity for these cases was 100 p. 100. There was a close correlation (R = 0,89, p less than 0,01) between the Doppler index and the degree of regurgitation assessed by selective right ventricular angiography.