EuroPCR2026-images-98460-Black-white-tiger-stripe

Tiger stripes are band-like signals appear to be associated with an intracardiac oscillating structure1 with the first band (lowest frequency on the Doppler recording) representing its fundamental frequency. These structures vibrate with a single frequency (not chaotic) with several harmonic overtones.2,3 The definite is believed to be caused by fluttering of the disrupted cusp leading to shedding of vortices in both retrograde and orthograde direction. The number of striations in the signal is likely to be related to the frequency of oscillation of the cusp and the presence or absence of mottling to the pattern of shedding of the vortices, also it can be related to the severity of the regurgitation. It is assumed that the streak numbers depend on the direction of blood flow, especially in the case of eccentric regurgitation. These tiger stripe frequencies may also occur in the absence of blood flow turbulence as seen in native valve.5 Occasionally, these “Tiger stripes” or “Zebra stripes” have been attributed to flail prosthetic valve leaflet6,7 native valve regurgitation without flail leaflet8,9 papillary muscle rupture in acute coronary syndrome,9 and possibly Lambl's excrescences. Harrison et al.10 and Jacovella et al. reported a small number of patients with diastolic flutter in the presence of paraprosthetic leaks and normal cusps. Hatle and Angelsen11 presented a brief description of findings similar to tiger stripes sign in native mitral and aortic valves but without a pathologic correlation. The presence of this finding in pathological conditions like rheumatic carditis suggests valvulitis. Once identified, the patient can be treated for carditis and with the passage of time, this finding subsides.References:1. Pennestri F, Bocardi L, Minardi G: Doppler study of precordial musical murmurs. Am J Cardiol 1989;63(18):1390–1394 2. Sabbah HN, Magilligan DJ Jr, Lakier JB, et al: Hemo- dynamic determinants of the frequency and amplitude of a musical murmur produced by a regurgitant mi- tral bioprosthetic valve. Am J Cardiol 1982;50(1):53–583. McKusick VA, Murray GE, Peeler RG, et al: Musi- cal cardiovascular murmurs. Bull Johns Hopkins Hosp 1955;97:136–176. 4. Chambers JB, Monaghan MJ, Jackson G, et al. Doppler echocardiographic appearance of cusp tears in tissue valve prostheses. J Am Coll Cardiol. 1987;10:462. 5. Pennestri F, Boccardi L, Minardi G. Doppler study of precordial musical murmurs. Am J Cardiol. 1989;63:1390-1394. 6. Wilkins GT, Flachskampf FA, Weyman AE. Echo-Doppler assessment of prosthetic heart valves. In: Weyman AE, editor. Principles and Practice of Echocardiography. 2nd ed. Philadelphia: Lea & Febiger; 1994. pp. 1227–8.7. Kinney EL, Machado H, Cortada X. Cooing intracardiac sound in a perforated porcine mitral valve detected by pulsed Doppler echocardiography. Am Heart J. 1986;112:420–3.8. Rakesh J, Krishnan MN. Tiger stripes sign. JICC. 2015;5:138–40.9. Cervantes-Nieto JA, Rivera-Silverio DA, Gopar-Nieto R, Azar-Manzur F, Ruiz-Esparza ME, Raymundo-Martínez G. “Tiger stripes” sign in acute coronary syndrome. Signo “manchas de tigre” en síndrome coronario agudo. Archivos de cardiologia de Mexico. 2020;90:349–50.10.Jacovella G, Narducci C, Pino PG, Salati A. Echocardiographic features of porcine valve dysfunction. Am J Cardiol 1980;46:526.11. Halle L, Angelsen B. Doppler Ultrasound in Cardiology. Philadelphia: Lea & Febiger, 1985:278.

 

Tiger stripes are band-like signals appear to be associated with an intracardiac oscillating structure1 with the first band (lowest frequency on the Doppler recording) representing its fundamental frequency. These structures vibrate with a single frequency (not chaotic) with several harmonic overtones.2,3 The definite is believed to be caused by fluttering of the disrupted cusp leading to shedding of vortices in both retrograde and orthograde direction. The number of striations in the signal is likely to be related to the frequency of oscillation of the cusp and the presence or absence of mottling to the pattern of shedding of the vortices, also it can be related to the severity of the regurgitation. It is assumed that the streak numbers depend on the direction of blood flow, especially in the case of eccentric regurgitation. These tiger stripe frequencies may also occur in the absence of blood flow turbulence as seen in native valve.5 Occasionally, these “Tiger stripes” or “Zebra stripes” have been attributed to flail prosthetic valve leaflet6,7 native valve regurgitation without flail leaflet8,9 papillary muscle rupture in acute coronary syndrome,9 and possibly Lambl's excrescences. Harrison et al.10 and Jacovella et al. reported a small number of patients with diastolic flutter in the presence of paraprosthetic leaks and normal cusps. Hatle and Angelsen11 presented a brief description of findings similar to tiger stripes sign in native mitral and aortic valves but without a pathologic correlation. The presence of this finding in pathological conditions like rheumatic carditis suggests valvulitis. Once identified, the patient can be treated for carditis and with the passage of time, this finding subsides.References:1. Pennestri F, Bocardi L, Minardi G: Doppler study of precordial musical murmurs. Am J Cardiol 1989;63(18):1390–1394 2. Sabbah HN, Magilligan DJ Jr, Lakier JB, et al: Hemo- dynamic determinants of the frequency and amplitude of a musical murmur produced by a regurgitant mi- tral bioprosthetic valve. Am J Cardiol 1982;50(1):53–583. McKusick VA, Murray GE, Peeler RG, et al: Musi- cal cardiovascular murmurs. Bull Johns Hopkins Hosp 1955;97:136–176. 4. Chambers JB, Monaghan MJ, Jackson G, et al. Doppler echocardiographic appearance of cusp tears in tissue valve prostheses. J Am Coll Cardiol. 1987;10:462. 5. Pennestri F, Boccardi L, Minardi G. Doppler study of precordial musical murmurs. Am J Cardiol. 1989;63:1390-1394. 6. Wilkins GT, Flachskampf FA, Weyman AE. Echo-Doppler assessment of prosthetic heart valves. In: Weyman AE, editor. Principles and Practice of Echocardiography. 2nd ed. Philadelphia: Lea & Febiger; 1994. pp. 1227–8.7. Kinney EL, Machado H, Cortada X. Cooing intracardiac sound in a perforated porcine mitral valve detected by pulsed Doppler echocardiography. Am Heart J. 1986;112:420–3.8. Rakesh J, Krishnan MN. Tiger stripes sign. JICC. 2015;5:138–40.9. Cervantes-Nieto JA, Rivera-Silverio DA, Gopar-Nieto R, Azar-Manzur F, Ruiz-Esparza ME, Raymundo-Martínez G. “Tiger stripes” sign in acute coronary syndrome. Signo “manchas de tigre” en síndrome coronario agudo. Archivos de cardiologia de Mexico. 2020;90:349–50.10.Jacovella G, Narducci C, Pino PG, Salati A. Echocardiographic features of porcine valve dysfunction. Am J Cardiol 1980;46:526.11. Halle L, Angelsen B. Doppler Ultrasound in Cardiology. Philadelphia: Lea & Febiger, 1985:278.