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Bushra S Rana, Shaun Robinson, Rajeevan Francis, Mark Toshner, Martin J Swaans, Sharad Agarwal, Ravi de Silva, Amer A Rana and Petros Nihoyannopoulos

Tricuspid regurgitation natural history and treatment remains poorly understood. Right ventricular function is a key factor in determining prognosis, timing for intervention and longer-term outcome. The right ventricle is a thin walled chamber with a predominance of longitudinal fibres and a shared ventricular septum. In health, the low-pressure pulmonary circulation results in a highly compliant RV well equipped to respond to changes in preload but sensitive to even small alterations in afterload. In Part 1 of this article, discussion focuses on key principles of ventricular function assessment and the importance of right ventricular chamber size, volumes and ejection fraction, particularly in risk stratification in tricuspid regurgitation. Part 2 of this article provides an understanding of the causes of tricuspid regurgitation in the contemporary era, with emphasis on key patient groups and their management.

Open access

Daniel X Augustine, Lindsay D Coates-Bradshaw, James Willis, Allan Harkness, Liam Ring, Julia Grapsa, Gerry Coghlan, Nikki Kaye, David Oxborough, Shaun Robinson, Julie Sandoval, Bushra S Rana, Anjana Siva, Petros Nihoyannopoulos, Luke S Howard, Kevin Fox, Sanjeev Bhattacharyya, Vishal Sharma, Richard P Steeds, Thomas Mathew and the British Society of Echocardiography Education Committee

Pulmonary hypertension is defined as a mean arterial pressure of ≥25 mmHg as confirmed on right heart catheterisation. Traditionally, the pulmonary arterial systolic pressure has been estimated on echo by utilising the simplified Bernoulli equation from the peak tricuspid regurgitant velocity and adding this to an estimate of right atrial pressure. Previous studies have demonstrated a correlation between this estimate of pulmonary arterial systolic pressure and that obtained from invasive measurement across a cohort of patients. However, for an individual patient significant overestimation and underestimation can occur and the levels of agreement between the two is poor. Recent guidance has suggested that echocardiographic assessment of pulmonary hypertension should be limited to determining the probability of pulmonary hypertension being present rather than estimating the pulmonary artery pressure. In those patients in whom the presence of pulmonary hypertension requires confirmation, this should be done with right heart catheterisation when indicated. This guideline protocol from the British Society of Echocardiography aims to outline a practical approach to assessing the probability of pulmonary hypertension using echocardiography and should be used in conjunction with the previously published minimum dataset for a standard transthoracic echocardiogram.

Open access

Daniel X Augustine, Lindsay D Coates-Bradshaw, James Willis, Allan Harkness, Liam Ring, Julia Grapsa, Gerry Coghlan, Nikki Kaye, David Oxborough, Shaun Robinson, Julie Sandoval, Bushra S Rana, Anjana Siva, Petros Nihoyannopoulos, Luke S Howard, Kevin Fox, Sanjeev Bhattacharyya, Vishal Sharma, Richard P Steeds, Thomas Mathew and the British Society of Echocardiography Education Committee

Open access

Richard P Steeds, Martin R Cowie, Bushra S Rana, John B Chambers, Simon Ray, Janaki Srinivasan, Konstantin Schwarz, Christopher J Neil, Caroline Scally, John D Horowitz, Michael P Frenneaux, Cristina Pislaru, Dana K Dawson, Oliver J Rothwell, Keith George, John D Somauroo, Rachel Lord, Mike Stembridge, Rob Shave, Martin Hoffman, Euan A Ashley, Francois Haddad, Thijs M H Eijsvogels, David Oxborough, Reinette Hampson, Chris D Kinsey, Sothinathan Gurunathan, Anastasia Vamvakidou, Nikolaos Karogiannis, Roxy Senior, Shahram Ahmadvazir, Benoy N Shah, Konstantinos Zacharias, Dan Bowen, Shaun Robinson, Ugochukwu Ihekwaba, Karen Parker, James Boyd, Cameron G Densem, Charlotte Atkinson, Jonathan Hinton, Edmund B Gaisie, Dhrubo J Rakhit, Arthur M Yue, Paul R Roberts, Dean Thomas, Pat Phen, Jonathan Sibley, Sarah Fergey and Paul Russhard

Open access

Vishal Sharma, Martin Stout, Keith Pearce, Allan L Klein, Maryam Alsharqi, Petros Nihoyannopoulos, Jamal Nasir Khan, Timothy Griffiths, Kully Sandhu, Sinead Cabezon, Chun Shing Kwok, Shanat Baig, Tamara Naneishvili, Vetton Chee Kay Lee, Arron Pasricha, Emily Robins, Prathap Kanagala, Tamseel Fatima, Andreea Mihai, Robert Butler, Simon Duckett, Grant Heatlie, Haotian Gu, Phil Chowienczyk, Linda Arnold, Sean Coffey, Margaret Loudon, Jo Wilson, Andrew Kennedy, Saul G Myerson, Bernard Prendergast, Alice M Jackson, Vera Lennie, Peter Lee Luke, Christopher James Eggett, Loakim Spyridopoulos, Timothy Simon Irvine, Nashwah Ismail, Anita Macnab, Caroline Bleakley, Mehdi Eskandari, Omar Aldalati, Almira Whittaker, Marilou Huang, Mark J Monaghan, Thomas J Turner, Conor Steele, Anna Barton, Alan C Cameron, Sonecki Piotr, Phang Gyee Vuei, Christos Voukalis, Hwee Phen Teh, Stavros Apostolakis, Chih Wong, Matthew M Y Lee, Nicolas E R Goodfield, Emma Lane, David Slessor, Richard Crawley, Theodoros Ntoskas, Farhanda Ahmad, Paul Woodmansey, Andrew J Fletcher, Shaun Robinson, Bushra S Rana, Liam Batchelor, Brogan McAdam, Caroline J Coats, Louise C Mayall, Niall G Campbell and Hannah Garnett