[An optimized contrast echocardiographic method for the detection and quantification of tricuspid valve insufficiency].

In 47 patients the incidence and extent of tricuspid insufficiency (TI) was determined by two different contrast echocardiographic methods. In 18 patients severe mitral stenosis, in 7 patients combined mitral valve disease and in 6 patients severe mitral insufficiency were diagnosed by cardiac catheterisation. 3 patients had mitral and aortic insufficiency, one patient severe aortic stenosis and 2 patients aortic insufficiency. In 9 patients the study was performed after mitral valve replacement, in 1 patient after aortic valve replacement. 1 patient had no valvular heart disease. All patients underwent right heart catheterisation and biplane cineventriculography of the right ventricle within two days of echocardiography. Method A: Echocardiography of the inferior vena cava. Method B: Direct contrast echocardiography of the tricuspid valve in the short parasternal plane. Compared with the hemodynamic study, sensitivity of method A was 62% and specificity 89% in detection of TI. Both the sensitivity and specificity of method B were 100%. A TI grade I was diagnosed in 6 of 10 patients with method A and in 9 of 10 patients with method B, a TI grade II in 8 of 9 patients with method A and in 10 with method B. A severe TI (III) was diagnosed in only 4 of 7 patients with method A and in all 7 patients with method B. The results suggest that direct contrast echocardiography of the tricuspid valve in patients with rheumatic valve disease is a highly sensitive and specific method in detection and quantification of TI in comparison to the vena cava method.