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TAPSE: Tricuspid Annular Plane of Systolic Excursion

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TAPSE (Tricuspid Annular Plane of Systolic Excursion)

Tricuspid Annular Plane of Systolic Excursion (TAPSE) is a way to use ultrasound to obtain a right ventricular systolic function[1] [2][3]. You can also use the right ventricular fractional area change method (RVFAC) [1][3], although it would require an ultrasound with a cardiac package to assess the area of change [4]. For this reason, TAPSE is more commonly used when needing a more accurate assessment of the right ventricular function [1][3][5].

Use

The right ventricle can change in both acute and chronic circumstances, and acknowledging these changes with ultrasound can better help assess both cause and treatment for patients [4][5] [6]. Some of the diseases able to be detected include: acute right sided myocardial infarctions, submassive or massive pulmonary emboli, pulmonary hypertension and others [3][5][7].

Normal Physiology

Normal right ventricles should be about two-thirds the size of the left ventricle.[4]. In a healthy heart, the right ventricle contracts from the bottom up, or from the base to the apex of the heart [1][4]. This means that when the heart is in contraction, or systole the annulus of the tricuspid valve is maximally displaced during that time [3]. In a healthy individual, this should be reflected in a larger movement of the tricuspid valve. The goal of TAPSE is to measure this displacement in systole to visualize how well the tricuspid valve moves [1]

How to Perform

The optimal way to visualize TAPSE is by first obtaining an apical-4-chamber view of the heart [8]. This is best done on the patient’s left side of the body, just lateral and under the nipple. Once the 4-chamber view is appreciated, it is important to change from 2D views to M mode. With this setting, you can visualize the function of the heart in its natural cardiac cycle. The cursor should then be placed at the lateral most border of the tricuspid annulus for several cycles. Increasing the gain can help better acquire the image. Once the operator feels satisfied in their views and images, they can freeze the image and make the calculation. Calipers are used to measure the annular displacement (peak to peak) [3][4].

Abnormal Physiology

With pathologic findings of the right ventricle. The patient will have poor or limited movement of their tricuspid valve during systole. This will be best appreciated in the measurements obtained, as anything less than 16mm or 1.6cm is something to be considered abnormal.[3][5]

References[edit]

  1. 1.0 1.1 1.2 1.3 1.4 Atout, Waleed, and Sherif Helmy. "Echocardiographic assessment of the right heart in adults." The Egyptian Heart Journal 66.1 (2014): 10.
  2. Kaul, Sanjiv, et al. "Assessment of right ventricular function using two-dimensional echocardiography." American heart journal 107.3 (1984): 526-531.
  3. 3.0 3.1 3.2 3.3 3.4 3.5 3.6 Saxena, Neil, et al. "Tricuspid annular systolic velocity: a useful measurement in determining right ventricular systolic function regardless of pulmonary artery pressures." Echocardiography 23.9 (2006): 750-755.
  4. 4.0 4.1 4.2 4.3 4.4 Excerpt From: Mike Mallin & Matthew Dawson. “Introduction to Bedside Ultrasound: Volume 2.” Emergency Ultrasound Solutions, 2013. iBooks. https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewBook?id=647356692
  5. 5.0 5.1 5.2 5.3 Tamborini, Gloria, et al. "Feasibility and accuracy of a routine echocardiographic assessment of right ventricular function." International journal of cardiology 115.1 (2007): 86-89.
  6. Perera, Phillips, et al. "The RUSH exam: Rapid Ultrasound in SHock in the evaluation of the critically ill." Emerg Med Clin North Am 28.1 (2010): 29-56.
  7. Bleeker, G. B., et al. "Assessing right ventricular function: the role of echocardiography and complementary technologies." Heart 92.suppl 1 (2006): i19-i26.
  8. Rudski, Lawrence G., et al. "Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography: endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography." Journal of the American Society of Echocardiography 23.7 (2010): 685-713.


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