The assessment of the etiology and severity of functional tricuspid regurgitation (FTR) has many limitations, especially when tricuspid regurgitation (TR) is more than severe. Instead of relying solely on TR severity, a new approach not only takes into account the severity of TR, but also pays strict attention to tricuspid annular dilation (size), the mode of tricuspid leaflet coaptation, and tricuspid leaflet tethering-factors often influenced by right ventricular enlargement and dysfunction. To simplify things, we propose a new staging system for functional tricuspid valve pathology using 3 parameters that may more accurately reflect the severity of the disease: TR severity, annular dilation, and mode of leaflet coaptation (extent of tethering). We believe that by utilizing these parameters, cardiologists and cardiac surgeons will be offered a better system for appraisal and decision-making in FTR.
M-mode echocardiograms of six patients with a diagnosis of Ebstein's anomaly and confirmed by cardiac catheterization were reviewed. All the patients (5 females and 1 male) were Caucasians with their ages ranging from one day to twenty-six years. The tricuspid valve was easily located in all the echo cardiographic studies. There was a 45 to 100 msec delay in tricuspid valve closure as compared to the mitral valve closure, in all patients. The amplitude of the anterior tricuspid valve was found to be greater than the amplitude of the anterior mitral valve in all but one case. Paradoxical septal movement type A was observed in four cases. None of the cases had a right ventricular end diastolic diameter that was larger than the left ventricular end diastolic diameter. The study found that it was extremely difficult to specifically diagnose Ebstein's anomaly with M-mode echocardiography alone, as each case has not been able to meet with all the criteria for diagnosis, described by various investigators.