Stewart D, Leman R B, Kaiser J, Mann D L
Cardiac Ultrasound Laboratory Charleston Veterans Administration Medical Center, SC.
Chest. 1991 Mar;99(3):651-5. doi: 10.1378/chest.99.3.651.
The incidence and severity of catheter-induced tricuspid regurgitation has not been studied extensively. Given the frequency with which right heart catheters are employed to measure cardiac output, it is important to know whether the severity of catheter-induced tricuspid regurgitation is sufficient to invalidate the measurement of thermodilution cardiac output. Accordingly, the purpose of the present prospective study was to determine the incidence and severity of catheter-induced tricuspid regurgitation in 25 men (mean age, 58.1 +/- 1.4 years) using Doppler ultrasound. The tricuspid valve was interrogated from two orthogonal views using pulsed-wave and color flow Doppler, either in the presence or absence of a 7-French catheter across the tricuspid valve. The severity of catheter-induced tricuspid regurgitation was graded semiquantitatively using a validated scoring system. Pulsed-wave Doppler studies showed that the incidence of catheter-induced tricuspid regurgitation was 48 percent, and that the average tricuspid regurgitation score increased from 0.41 +/- 0.16 to 0.61 +/- 0.17 (p less than 0.01). Color flow Doppler studies showed similar findings. Further, the incidence of catheter-induced tricuspid regurgitation was not related to the patient's underlying hemodynamic status or right ventricular geometry. In conclusion, this study shows for the first time that the quantitative extent of catheter-induced tricuspid regurgitation is small, and is therefore unlikely to be important clinically, particularly with regard to the assessment of thermodilution cardiac output.
导管相关性三尖瓣反流的发生率及严重程度尚未得到广泛研究。鉴于右心导管用于测量心输出量的频率较高，了解导管相关性三尖瓣反流的严重程度是否足以使热稀释法心输出量测量无效很重要。因此，本前瞻性研究的目的是使用多普勒超声确定25名男性（平均年龄58.1±1.4岁）中导管相关性三尖瓣反流的发生率及严重程度。通过脉冲波和彩色血流多普勒从两个正交视图对三尖瓣进行检查，检查时存在或不存在穿过三尖瓣的7F导管。使用经过验证的评分系统对导管相关性三尖瓣反流的严重程度进行半定量分级。脉冲波多普勒研究显示，导管相关性三尖瓣反流的发生率为48%，三尖瓣反流平均评分从0.41±0.16增加到0.61±0.17（p<0.01）。彩色血流多普勒研究显示了类似的结果。此外，导管相关性三尖瓣反流的发生率与患者潜在的血流动力学状态或右心室形态无关。总之，本研究首次表明，导管相关性三尖瓣反流的定量程度较小，因此在临床上不太可能具有重要意义，尤其是在评估热稀释法心输出量方面。
