How to get an Tricuspid Valve Gradient by Peak Velocity.
Obtain a continuous wave doppler of the tricuspid valve. The optimal view is the midesophageal or gastroesophageal of the long axis of the tricuspid valve. In this view the tricuspid valve is in it's long axis and provides the best angle to doppler the gradient's across the valve. An alternative view is the bicaval view of the atrial septum where the tricuspid valve is visible or the RVIO view where a good angle can be obtained. Occasionally, a transgastric view of the tricuspid valve may also offer a good angle of the tricuspid valve. Once the view is obtained turn on the CWD and use the track ball to move the CWD line to the tricuspid valve. A doppler profile of the tricuspid valve should be displayed with high velocities in tricuspid stenosis. If a poor or low velocity doppler wave form is displayed reposition the view and move the CWD line thru out the valve. The CWD must be parallel to the stenotic jet to pick up the maximal velocity and obtain a good doppler wave form. After a good doppler wave form is obtained look at the morphology of the waveform and note it. A profile that has a large gradient across the valve will exhibit a "filling in" pattern, whereas a low or normal gradient flow profile will have a scattered filled in pattern. The amount of filling of the flow profile is related to the amount of turbulence across the valve. Place the trackball point at the peak of the flow profile and note the velocity.