DK2985_C000 1..28 - AlSharqia Echo Club

Pulmonic and Tricuspid Valves 463ANTERIORremodeling. Dehiscence of a DeVega suture annuloplastymay appear on TEE as a horizontal linear echo-densityrunning across the TV plane.SEPTALPOSTERIORB. Annuloplasty RingsTricuspid annuloplasty rings appear on tomographicecho planes as two echodense annular structures locatedat the base of opposite leaflets on the atrial side of thevalve, with variable acoustic shadowing (Fig. 19.21).Tricuspid leaflet mobility is expected to be somewhatreduced but stenosis is rare as the annular dimensionsremain large. Tricuspid regurgitation or vegetation areusually easily demonstrated at 30–908 (Fig. 19.22), inthe mid-esophageal, the transitional gastroesophageal,and the sagittal transgastric views.CSFigure 19.20 Double purse-string suture technique inDeVega’s annuloplasty of the tricuspid valve (CS, coronarysinus). [Adapted with permission of Rabago et al. (38).]VIII.VALVE REPLACEMENTThe American College of Cardiology and the AmericanHeart Association established in 1998 guidelines for the(A)(B)TRICUSPID ANNULUSRARV(C)(D)EKG200100PaPrvTRICUSPID ANNULUS0mmHgPraPA CATHETERFigure 19.21 (A, B) Echocardiographic appearance of a tricuspid valve prosthetic annulus. (C) After the procedure no significantstenosis is present as demonstrated by the absence of a diastolic gradient across the tricuspid valve is confirmed on the simultaneousright atrial pressure (Pra) and right ventricular pressure (Prv) tracings obtained through the paceport of the pulmonary artery (PA) catheter.(D) Intraoperative findings (EKG, electrocardiogram; Pa, arterial pressure; RA, right atrium; RV, right ventricle). (Photo D courtesyof Dr. Denis Bouchard.)