987-107 Transesophageal Doppler Analysis of Coronary Sinus Flow: A New Method to Assess the Severity of Tricuspid Regurgitation

Abstract

Our aim was to assess the differences in the Doppler flow pattern of the coronary sinus (CS) in patients without tricuspid regurgitation (TR) and with mild (Mi), moderate (Mo) or severe (Se) TR. For this purpose, 35 patients without TR and 70 patients (mean age 57 ± 8 years, 57% males) with different degrees of TR (27 Mi, 14 Mo, 29 Se) underwent a prospective study in which the Doppler flow pattern of the CS obtained by transesophageal echocardiography was analyzed. Adequate Doppler signals of the CS were obtained in 22 (63%) patients without TR and in 50 (71%) patients with TR (18 Mi [65%], 10 Mo [73%], 22 Se [75%]). The CS flow was analyzed by TEE in a transverse plane, showing its drainage into the right atrium, close to the tricuspid valve. All patients without TR or with Mi TR showed a typical CS Doppler flow pattern with 2 waves, a late systolic one and another diastolic with larger amplitude and velocity. When we analyzed those patients with Se TR, the late systolic flow became reversed (retrograde) and a Color-Doppler turbulent flow in the CS was found in 96% of them. This reversed systolic wave (RSyW) was also found in 50% of the patients with Mo TR, all of them with eccentric regurgitation jets. The sensitivity (SE), specificity (SP) and diagnostic accuracy (DA) of the presence of a RSyW in the CS for the diagnosis of severe TR was 95%, 82% and 81% respectively. In conclusion, significant TR modifies the CS flow pattern assessed by transesophageal echocardiography. The presence of a reversed systolic flow in the CS can be a new sign with good SE, SP and DA in the diagnosis of severe tricuspid regurgitation.