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Year : 2018  |  Volume : 2  |  Issue : 2  |  Page : 139-140

Tiger stripes sign


Department of Cardiology, Government Medical College, Kozhikode, Kerala, India

Date of Web Publication6-Sep-2018

Correspondence Address:
Dr. Kailash Kumar Goyal
Department of Cardiology, Super-Specialty Block, Government Medical College, Kozhikode - 673 008, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiae.jiae_78_17

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How to cite this article:
Goyal KK, Mukund DE, Sajeev CG. Tiger stripes sign. J Indian Acad Echocardiogr Cardiovasc Imaging 2018;2:139-40

How to cite this URL:
Goyal KK, Mukund DE, Sajeev CG. Tiger stripes sign. J Indian Acad Echocardiogr Cardiovasc Imaging [serial online] 2018 [cited 2018 Dec 14];2:139-40. Available from: http://www.jiaecho.org/text.asp?2018/2/2/139/240645

Tiger stripes sign refers to high amplitude band-like signals seen in Doppler spectral recordings. This was usually considered to indicate the presence of a flail porcine prosthetic mitral leaflet.[1] However, it can be associated with any other intracardiac oscillatory or vibratory structure [2] or even with native valve regurgitation. Davogustto et al.[3] showed the presence of tiger stripes sign in a patient with Lambl's excrescences. We here in report two cases of tiger stripes associated with native valve regurgitation. In the first case, a 35-year-old male with a history of rheumatic fever presented for cardiac evaluation. His blood pressure was 130/80 mmHg, and pulse rate was 64/minute. Cardiac auscultation revealed a short mid-diastolic murmur at the apex along with a grade 3/5 systolic murmur. Transthoracic echocardiogram showed rheumatic mitral valve with mild mitral stenosis and mild regurgitation [Figure 1]a. Continuous wave Doppler spectral recording of mitral inflow showed the presence of band-like signals indicating tiger stripes sign [Figure 1]b. For the second case, a 60-year-old male was being evaluated for atypical chest pain. Echo showed aortic valve sclerosis with mild aortic regurgitation and continuous wave Doppler showed the presence of tiger stripes sign [Figure 2]a and [Figure 2]b.
Figure 1: (a) Two-dimensional echo showing rheumatic mitral valve with mild mitral regurgitation (b) Continuous wave Doppler showing tiger stripes

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Figure 2: (a) Echo showing aortic valve sclerosis with aortic regurgitation (b) Continuous wave Doppler showing tiger stripes

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The presence of tiger stripes sign in both rheumatic as well as nonrheumatic native valvular regurgitation in our cases suggest that it is not a specific sign of a flail prosthetic mitral valve and can be present even in native valvular regurgitation irrespective of etiology. The definite mechanism leading to the formation of tiger stripes is not known. It was believed to be caused by fluttering of the disrupted cusp leading to shedding of vortices in both retrograde and orthograde direction.[4] However, it is considered that any intracardiac oscillating structure vibrating with a single high frequency (not chaotic) with several harmonic overtones can give rise to tiger stripes sign.[5]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Feigenbaum H, Armstrong WF, Ryan T. Feigenbaum's Echocardiography. 7th ed. Philadelphia: Lippincott Williams and Wilkins; 2010. p. 318-9.  Back to cited text no. 1
    
2.
Kerut EK. Tiger stripes. Echocardiography 2007;24:558-9.  Back to cited text no. 2
    
3.
Davogustto G, Fernando RR, Loghin C. Lambl's excrescence, migrainous headaches, and “tiger stripes”: Puzzling findings in one patient. Tex Heart Inst J 2015;42:70-2.  Back to cited text no. 3
    
4.
Chambers JB, Monaghan MJ, Jackson G, Jewitt DE. Doppler echocardiographic appearance of cusp tears in tissue valve prosthesis. J Am Coll Cardiol 1987;10:462-6.  Back to cited text no. 4
    
5.
Sabbah HN, Magilligan DJ Jr., Lakier JB, Stein PD. Hemodynamic determinants of the frequency and amplitude of a musical murmur produced by a regurgitant mitral bioprosthetic valve. Am J Cardiol 1982;50:53-8.  Back to cited text no. 5
    


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  [Figure 1], [Figure 2]



 

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