Reflected ultrasound in the diagnosis of tricuspid stenosis ∗

Abstract

Reflected ultrasound curves, which appear to reflect movement of the anterior leaflet of the tricuspid valve, have been obtained by directing the ultrasound beam toward the spine from the fourth or fifth left intercostal space. From this projection, the tricuspid valve lies anterior and medial to the position of the mitral valve pattern. Records were obtained from 31 patients with mitral valve disease and proved normal tricuspid valves. The configuration of the tricuspid pattern is similar to that established as the normal configuration for the mitral valve movement. The velocity of movement posteriorly, after initial opening of the tricuspid valve, was 60 to 125 mm./sec. in the subjects with normal tricuspid valves. Records were obtained from 6 patients with tricuspid stenosis. In contrast to the normal tricuspid pattern, the record from these patients demonstrated a marked delay in posterior movement after opening of the valve. The velocity of motion posteriorly from peak 4 in the pattern was reduced to 8 to 30 mm./sec. Although a tricuspid valve curve is difficult to obtain from subjects with no heart disease, a satisfactory record can be inscribed from most patients with mitral stenosis. This is the patient group in which the diagnosis of tricuspid stenosis is not most important. The validity and accuracy of this method in the determination of tricuspid stenosis has been demonstreated. The ultrasounddcardiogram, which has proved of definite clinical value in the assessment of mitral value disease, therefore can be applied as a useful clinical diagnostic method for the study of tricuspid disease.