Answers: 1. Tricuspid Valve 2. Right Parasternal View
While the right parasternal view is essential for accurate quantification of aortic stenosis - subtle hand movements can give an an-face view of the tricuspid valve
To obtain the right parasternal view:
1. Lie the patient in the RIGHT lateral position with right hand under the head
2. Obtain the standard PLAX view in this position
3. Follow the path of the ascending aorta across the sternum
4. Rock medially + tail up
The probe now faces down the ascending aorta through the AV
Color doppler shows direction of flow toward the probe
The associated CW doppler signal is therefore above the baseline
Once the angle is identified with 2D and color doppler, the pedoff probe is then used to accurately assess gradients.
1/9 Tuesdays Tweetorial:
You are in cardiothoracic theatre doing a mitral valve replacement for severe MR
The anaesthetic consultant is doing a TOE and keeps saying 'PISA'
U know its in Italy but have no idea why he keeps saying it
What is PISA and why is it used?
2/9 PISA = Proximal Isovelocity Surface Area
Blood is ejected -> LA
It converges at the mitral regurgitant orifice it forming hemispheres -> different blood velocity in each hemisphere
RCCs that are equidistant from the orifice(in each hemisphere) travel at similar speed
3/9 Each hemisphere has a radius
The radius that matters for calculations is the one where aliasing occurs (where color changes from blue to red or red to blue)
Remember:
Blue: RCCs moving Away from probe
Red: Towards the probe
The tricuspid regurgitation jet velocity shown was used in a critical care patient to estimate RV systolic pressure:
Vol control – tvol 420ml PEEP 10cmH20
Cardiovascular: MAP 67mmHg on Noradrenaline 0.3mcg/kg/min
2/13
His TRVmax is high:
Why should I not diagnose this patient with pulmonary hypertension in my echo report?
2 are correct:
a. not steady state
b. Off axis cursor
c. Echo cannot diagnose it
d. Poor 2D view
3/13
Answer:
a, c and possibly b!
Lets start with what TR vmax means and how it is calculated