SIGNIFICANCE OF LAMINAR SYSTOLIC REGURGITANT FLOW IN PATIENTS WITH TRICUSPID REGURGITATION - A COMBINED PULSED-WAVE, CONTINUOUS-WAVE DOPPLER AND 2-DIMENSIONAL ECHOCARDIOGRAPHIC STUDY

To define the significance of laminar systolic tricuspid regurgitant (TR) flow, pulsed-wave and continuous-wave Doppler (PWD, CWD), and two-dimensional and M-mode echocardiography (2-DE, M-mode) were performed in 68 patients with TR, which included five patients with tricuspid valvectomy. The pattern of TR flow (laminar versus turbulent), TR severity (the distance that the regurgitant flow extended into the right atrium [1+ to 4+ as measured by PWD]), the peak flow velocity of TR by CWD, the presence or absence and the amount of systolic tricuspid cusp separation by 2-DE, and the dimension of the right ventricle and the inferior vena cava by M-mode, were assessed. A laminar pattern of TR flow in systole was obtained in 21 patients, five of whom had undergone tricuspid valvectomy. Fourteen of 21 had visible tricuspid cusp separation in systole on 2-DE; of the seven who had no visible tricuspid cusp separation during systole, five had undergone tricuspid valvectomy. All 47 patients with a turbulent pattern of TR flow had no visible systolic tricuspid cusp separation. Severe 4+ TR was present in 14 of 21 (67%) patients with laminar TR flow and in 4 of 47 (9%) patients with turbulent TR flow (p<0.001). The peak flow velocity of TR in patients with laminar TR flow (2.0±0.7 m/sec) was lower (p<0.001) than in those with turbulent TR flow (3.1±0.7 m/sec). The dimension of the right ventricle and inferior vena cava were larger (p<0.001) in patients with laminar TR flow (38.2±9.4 mm, mean±SD; and 27.2±7.1 mm, respectively) than in those with turbulent TR flow (24.7±9.5 mm and 19.1±4.2 mm, respectively). The distance of systolic tricuspid cusp separation (tricuspid anulus in patients with tricuspid valvectomy) ranged from 3 to 40 mm and was inversely correlated with the peak flow velocity of TR (r=-0.94, SEE=0.1 m/sec, y=e1.1-0.04x, p<0.001) in 19 patients with laminar TR flow. We conclude that laminar TR flow is strongly suggestive of the presence of severe TR and it is probably due to a large regurgitant orifice. © 1990.