Still difficult to conclude ? Look at the following Image.
Tricuspid regurgitation is significant . www.drsvenkatesan.com
If you have thought . . .
All are acceptable differential diagnosis
But the real diagnosis is none of the above .
Need more time . . . the following Doppler tracing will settle the issue !
Doppler velocity in RVOT at 88mmhg. www.drsvenkatean.com
The final diagnosis was . . .
Here , RV functional assessment becomes vital , but it is difficult many times. A simple clue is , as the RV is able to generate 88mmhg pressure it implies , the contractility should be near normal .
RV EF %, RV Dp/Dt , Tricuspid annular motion by tissue Doppler are additional measures. Cine MRI can be a useful investigation prior to intervention.