Significant Drop in Right Atrial Pressure Does Not Influence Fractional Flow Reserve Coronary Assessment.

The effect of a highly elevated level of right atrial filling pressure on fractional flow reserve (FFR) measurement remains unclear. Transcatheter tricuspid valve intervention, a recently introduced option for inoperable or high-risk patients, represents a unique model of in-vivo physiology to investigate the eventual influence of central venous pressure on coronary FFR measurements. The case is reported of a patient with a degenerated tricuspid surgical bioprosthesis who underwent transcatheter tricuspid valve-in-valve replacement and concomitant coronary functional assessment with FFR. In an experimental model, the significant fall in right atrial pressure did not influence FFR measurements in the presence of angiographically proven mild coronary artery disease.

Doppler echocardiographic assessment of the valve area in patients with atrioventricular valve stenosis by application of the continuity equation.

The orifice area was non-invasively assessed in 19 patients with mitral or mitral and tricuspid stenosis by combined cross-sectional and Doppler echocardiography. Stroke volume was calculated as the product of aortic or pulmonic cross-sectional area and the time velocity integral of the flow across that valve, and the stenotic valve area was obtained as the stroke volume divided by the time velocity integral of the stenotic valve. In addition, the mitral valve area was estimated by the pressure half-time method of Hatle et al. The non-invasive determinations were compared with those calculated by the Gorlin formula at cardiac catheterization. The valve area obtained by combined cross-sectional and Doppler echocardiography showed a close correlation with the Gorlin area, r = 0.90, SEE = 0.13 cm2, n = 20. In contrast, the valve area estimated by the pressure half-time method showed only a moderate correlation with the Gorlin area, r = 0.68, SEE = 0.38 cm2, n = 18, and estimates by this method tended to significantly overestimate the Gorlin area. In conclusion, non-invasive valve area determinations based on combined cross-sectional and Doppler echocardiography can be used to accurately quantify the severity of the lesion in patients with atrioventricular valve stenosis, while determinations by the pressure half-time method may show errors of a magnitude that limits its clinical applicability.

Non-invasive diagnosis and assessment of tricuspid regurgitation and stenosis using one and two dimensional echo-pulsed Doppler.

Twenty normal subjects and 82 patients with valvular heart disease, whose lesions were independently assessed either by cardiac catheterisation and/or at operation, were studied using the pulsed Doppler technique combined with either one or two dimensional echocardiography. Of these, 41 patients had tricuspid lesions, including 40 with regurgitation and nine with stenosis. The tricuspid analogue flow velocity trace and the Doppler frequency spectrum (time interval histogram) were recorded. Characteristic differences were found between the records from subjects with and without tricuspid lesions. In subjects with tricuspid regurgitation there was a systolic negative wave on the analogue velocity display and broadening of the time interval histogram. In subjects with tricuspid stenosis there was an abnormal pattern, and significantly increased duration of the diastolic wave on the analogue velocity trace, again with broadening of the time interval histogram. Sensitivity and specificity ranged between 85 and 95%. The calculated ratio between the measured amplitudes of the systolic and diastolic waves correlated well with independently performed grading of the regurgitation on a three point scale in 85% of cases. Grading of the severity of tricuspid stenosis on a three point scale based on studies of the diastolic Doppler velocity anomalies was the same in 85% of cases as the grading based on established invasive techniques. The addition of two dimensional echocardiography to the pulsed Doppler technique increased the sensitivity for mild lesions.