[Two-dimensional contrast echocardiography of hepatic veins in the diagnosis of tricuspid regurgitation (author's transl)].

The diagnosis of tricuspid regurgitation (TR) is often controversial. We used peripheral venous contrast echocardiography for the detection and the quantitative assessment of valvular regurgitation. We studied 10 normal subjects, 7 patients with atrial fibrillation, but without tricuspid lesions, 36 patients with TR confirmed by right heart catheterization, divided in three subgroups, according to ventriculography and jugular pulse recording: 10 cases with mild TR, 17 cases with moderate TR, 9 with severe regurgitation. After the injection of contrast medium (CM) (saline solution), the regurgitant flow was visualized in the hepatic veins (HV) and in the inferior vena cava (IVC), by two-dimensional subxiphoid projections; the time of disappearance of the CM was studied by time-motion echograms. The appearance of CM in the HV and in IVC wasn't demonstrated in any normal case. Subjects with atrial fibrillation alone, showed, in 71,5% of cases of persistence of CM in IVC for less than 10 cardiac beats. The diagnosis of severe TR was correctly made in 100% of cases; in all the patients the CM was showed in the HV for more than 40 beats. In patients with mild TR, the diagnosis was correct in 60% of cases with a short persistence of the CM in the HV. In the other cases of mild TR, the presence of CM in HV was misinterpreted as due to atrial fibrillation. Moderate TR was correctly recognized in 70.5% of patients, while in the remainder it was under or overestimated. The method shows a good sensitivity; some cases with atrial fibrillation, in the absence of TR, may cause "false-positive" diagnosis.