TRANSESOPHAGEAL DOPPLER ANALYSIS OF CORONARY SINUS FLOW - A NEW METHOD TO ASSESS THE SEVERITY OF TRICUSPID REGURGITATION

Background: Severe mitral regurgitation induces reversal of flow in th e pulmonary veins. We hypothesized that severe tricuspid regurgitation may disrupt normal coronary sinus flow. The purpose of this study was to analyze the Doppler flow pattern of the coronary sinus and to dete rmine its value in the assessment of the severity of tricuspid regurgi tation. Methods: The coronary sinus flow was analyzed in 70 consecutiv e patients with some degree of tricuspid regurgitation (27 mild, 14 mo derate, and 29 severe) and in 35 patients without tricuspid regurgitat ion. The coronary sinus flow was obtained by pulsed-Doppler transesoph ageal echocardiography in a transverse plane, which showed its drainag e into the right atrium. Results: The number of patients with adequate studies of the coronary sinus tended to increase with the severity, o f the tricuspid regurgitation. III patients without or with only mild tricuspid regurgitation the coronary sinus Doppler flow pattern was fo rmed by two negative waves, a Late systolic wave and another diastolic one with higher velocity and Longer duration. The systolic wave becam e reversed in 21 (96%) of the patients with severe tricuspid regurgita tion. The sensitivity, specificity, and diagnostic accuracy of the pre sence of a reversed systolic wave in the coronary sinus for the diagno sis of severe tricuspid regurgitation was 95%, 82%, and 80%, respectiv ely. Conclusions: Significant tricuspid regurgitation modifies the cor onary sinus flow pattern as assessed by transesophageal echocardiograp hy. The presence of a reversed systolic flow in the coronary sinus app ears to be a reliable new sign with good sensitivity, specificity, and diagnostic accuracy for the diagnosis of severe tricuspid regurgitati on.