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[Echocardiograms of a monophasic triangular wave of the tricuspid valve]
Abstract:
The echocardiographic and clinical study was performed in six patients (three acute pulmonary embolism, one for each hypertensive cardiomyopathy, ischemic heart disease and primary pulmonary hypertension) who had a diastolic monophasic triangular pattern of the tricuspid valve echogram. Left-sided and right-sided IRT / square root R-R, ICT / square root R-R, PEP, Q-Mc and Q-Tc, and PEP / ET (IRT; isovolumic relaxation time, ICT; isovolumic contraction time, PEP; preejection time, Q-Mc or Q-Tc; interval of the Q wave of the ECG to the closing point of the mitral or tricuspid valve, and ET; ejection time) were measured from echocardiograms, and the comparisons of these parameters were made between two kinds of echogram with or without triangular pattern of the tricuspid valve. There were no significant differences in the left-sided parameters between the two kinds of echocardiograms. The mitral valve echogram showed a persistent M-shaped pattern irrespective of the pattern of the tricuspid valve. Right-sided IRT / square root R-R and ICT / square root R-R were significantly prolonged and Q-Tc was significantly shortened in the echogram with a triangular pattern of the tricuspid valve. Right ventricular (RV) catheterization was performed using a Swan-Ganz catheter in four patients with the triangular pattern of the tricuspid valve echogram. The mean pulmonary artery pressure ranged from 24 to 96 mmHg (40 mmHg on an average) and RV end-diastolic pressure from 8 to 17 mmHg (12 mmHg on An average). The possible explanation for the production of the triangular tricuspid valve echogram was an impaired early diastolic relaxation and increased stiffness of the RV due to the acute pressure overloading, resulting in a delayed opening and an early closing of the tricuspid valve. We conclude that a diastolic monophasic triangular pattern of the tricuspid valve echogram is a reflection of an impaired early diastolic relaxation and an increased end-diastolic stiffness of the RV.