Detection of tricuspid regurgitation and estimation of central venous pressure by two-dimensional contrast echocardiography of the right superior hepatic vein.
Two-dimensional echocardiography (2DE) was utilized to visualize the right superior hepatic vein (RSHV) for detection of tricuspid regurgitation (TR) and estimation of central venous pressure (CVP). Patients were divided into two groups. Eighteen patients were placed in group I on the basis of typical clinical features of TR (five patients) or 2DE contrast evidence of TR (13 patients). Group II included 55 patients without TR. Maximal transverse dimension of RSHV of at least 1.8 cm (range 1.8 to 3.8 cm, mean 2.4 cm) identified all patients in group I (100% sensitivity). One patient in Group II had RSHV width of 2.1 cm (96% specificity). Predictive value was 95%. RSHV width ranged from 0.4 to 2.1 cm (mean 1.3 cm) in group II. Mean values for group I and II were significantly different (p less than 0.001). Linear regression analysis was utilized to compare CVP and maximal RSHV width in 42 patients (15 group I and 27 group II). The slope of the line was significantly different from zero (p less than 0.005); the correlation coefficient was 0.70. In patients with maximal RSHV width greater than 1.5 cm, the predictive value for elevated CVP (greater than 6 mm Hg) was 87% with 69% sensitivity and 78% specificity. In 13 group II patients with technically satisfactory 2DE but no distinctly visible RSHV, CVP ranged from 4 to 12 mm Hg with four elevated values (greater than 6 mm Hg). Predictive value of normal CVP in absence of visible RSHV was 69%. This study suggests that determination of maximal RSHV width is useful in detection of TR and may be helpful in estimation of CVP.
D002496:Central Venous Pressure; D004452:Echocardiography; D006325:Heart Atria; D006503:Hepatic Veins; D006801:Humans; D014262:Tricuspid Valve Insufficiency / Q000175:diagnosis*; D014682:Vena Cava, Inferior