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Transesophageal Doppler Analysis of Coronary Sinus Flow A New Method to Assess the Severity of Tricuspid Regurgitation
Author(s) -
ZAMORANO JOSÉ,
ALMERÍA CARLOS,
ALFONSO FERNANDO,
PEREZ MARÍA ANGELES,
GRAUPER CATHERINE,
MORALES RICARDO,
SÁNCHEZHARGUINDEY LUIS
Publication year - 1997
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/j.1540-8175.1997.tb00766.x
Subject(s) - medicine , regurgitation (circulation) , cardiology , coronary sinus , doppler echocardiography , tricuspid valve insufficiency , diastole , sinus (botany) , tricuspid valve , mitral regurgitation , radiology , blood pressure , botany , biology , genus
Background: Severe mitral regurgitation induces reversal of flow in the pulmonary veins. We hypothesized that severe tricuspid regurgitation may disrupt normal coronary sinus flow. The purpose of this study was to analyze the Doppler flow pattern of the coronary sinus and to determine its value in the assessment of the severity of tricuspid regurgitation. Methods: The coronary sinus flow was analyzed in 70 consecutive patients with some degree of tricuspid regurgitation (27 mild, 14 moderate, and 29 severe) and in 35 patients without tricuspid regurgitation. The coronary sinus flow was obtained by pulsed‐Doppler transesophageal echocardiography in a transverse plane, which showed its drainage into the right atrium. Results: The number of patients with adequate studies of the coronary sinus tended to increase with the severity of the tricuspid regurgitation. In patients without or with only mild tricuspid regurgitation the coronary sinus Doppler flow pattern was formed by two negative waves, a late systolic wave and another diastolic one with higher velocity and longer duration. The systolic wave became reversed in 21 (96%) of the patients with severe tricuspid regurgitation. The sensitivity, specificity, and diagnostic accuracy of the presence of a reversed systolic wave in the coronary sinus for the diagnosis of severe tricuspid regurgitation was 95%, 82%, and 80%, respectively. Conclusions: Significant tricuspid regurgitation modifies the coronary sinus flow pattern as assessed by transesophageal echocardiography. The presence of a reversed systolic flow in the coronary sinus appears to be a reliable new sign with good sensitivity, specificity, and diagnostic accuracy for the diagnosis of severe tricuspid regurgitation .