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Assessment of functional tricuspid regurgitation
Luigi P. Badano1*, Denisa Muraru1, and Maurice Enriquez-Sarano2
1Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani 2, Padua 35128, Italy; and2Division of Cardiovascular Diseases,
Mayo Clinic, Rochester, MN, USA
Received 2 October 2012; revised 8 December 2012; accepted 14 December 2012
Functional tricuspid regurgitation (FTR) is characterized by structurally normal leaflets and is due to the deformation of the valvulo-ventricu-
lar complex. While mild FTR is frequent and usually benign, patients with severe FTR may develop progressive ventricular dysfunction and
incur increased mortality. Therefore, FTR should not be ignored, should be appropriately diagnosed and quantified by Doppler echocardi-
ography, and should be evaluated for corrective surgical procedures. At present, referral for surgical correction of FTR is often delayed until
patients develop intractable heart failure. However, this strategy frequently translates in poor clinical outcome characterized by notable op-
erative mortality and reduced long-term survival. Appropriate patient selection and proper timing for tricuspid valve (TV) repair or replace-
ment are crucial for optimal outcome, but objective criteria for clinical decison-making remain poorly defined. In the present paper, we
review the anatomy of the normal TV, the pathophysiology of FTR, the assessment of its severity and functional significance, and
propose an algorithm for selecting patients for surgical treatment.
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Functional tricuspid regurgitation † Tricuspid valve † Echocardiography † Three dimensional †
Rightventricle † Pathophysiology
The aetiology of tricuspid regurgitation (TR) is generally divided
into organic [with intrinsic tricuspid valve (TV) disease] and func-
tional (FTR) in the absence of structural abnormalities of tricuspid
leaflets (Table 1). Organic TR results from structural abnormalities
of TV apparatus, may be congenital or acquired and accounts for
only 8–10% of all severe TRs.1,2Functional TR is a consequence
of deformation of the TV apparatus, such as dilation and geometric
deformation of tricuspid annulus (TA), and therefore the term
'secondary TR' is also used.
Functional TR is frequently caused by increased right ventricular
(RV) afterload and it is associated with advanced stages of left-
sided valve, myocardial or pulmonary diseases. In these patients,
moderate or severe TR has a significant impact on their functional
capacity and long-term survival,1and surgical repair or replacement
of the TV is the only corrective treatment presently available.
However, operations for symptomatic FTR have the reputation
for being high-risk procedures, particularly in candidates to redo
surgery after previous correction of left-sided heart valve
disease,3–5and several investigators support a more aggressive,
earlier surgical approach to FTR.6–8Another issue making the clin-
ical decision-making difficult is the notable rate of recurrence of
FTR after surgical repair,9which emphasizes the importance of a
detailed anatomic diagnosis prior to making the decision of a
repair vs. replacement approach.
Despite the general agreement regarding the need for appropri-
ate patient selection and optimal timing of surgical treatment of
FTR, there is a lack of objective criteria to guide clinicians in
proper assessment of patients with FTR.9
In this paper, we review the anatomy of the normal TV, the
pathophysiology of FTR, the assessment of its severity and func-
tional significance, and propose an algorithm for selecting patients
for surgical treatment.
Functional anatomy of the
tricuspid valve complex
The TV is the most caudally located and has the largest orifice
among the four cardiac valves.
Classically, the TV complex consists of three leaflets (anterior,
posterior, and septal) inserted on the narrow fibrous TA and
joined by chordae tendinae to their specific papillary muscles
attached to the RV myocardium (Figure 1). Effective valve function
depends on the integrity and coordination of these components.
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Both the anterior and posterior (also named mural or inferior)
tricuspid leaflets arise from the corresponding RV free wall. The
three leaflets are unequal in size: the anterior leaflet is the largest,
while the posterior leaflet is notable for the presence of multiple
scallops. The septal leaflet is the smallest and arises medially directly
from the TA above the membranous interventricular septum.
As shown in Figure 1, the anatomy of the mitral and TVs displays
many differences beyond the number of leaflets. The papillary
muscles are different than those supporting the mitral valve,
smaller, often multiple, widely separated, and carrying chordae to
a single TV leaflet. Finally, there may be accessory chordal attach-
ments to the RV free wall and to the moderator band. These
complex and multiple chordal connections play an important
role in the genesis of FTR, as they affect proper leaflet coaptation
in the setting of RV enlargement and dysfunction. Indeed, as mitral
papillary muscles each serve both leaflets, the separation of leaflets
by annular enlargement is limited, while the link of one tricuspid
leaflet to only one set of subvalvular support allows wide separ-
ation of leaflets with annular and cavity enlargement.
The TA is a complex (less symmetric than the 'saddle-shaped'
mitral annulus) non-planar, highly dynamic structure, which
changes in shape and size during the cardiac cycle due to the con-
traction of the surrounding myocardium.10It is oval in shape, with
the postero-lateral portion being 'lowest' (towards the RV apex)
and the antero-septal portion the highest.11Tricuspid annulus
diameter, circumference, and area are all larger than that of
mitral annulus by about 20%. Although values of major TA diam-
eter of 30–35 mm are described for normal adults, the orifice
size is related to body size. Thus, the average normal TA diameter
is 21 mm/m2.10The TA displays a ?19% reduction in annular cir-
cumference (?30% reduction in annular area) during atrial
systole.11It provides a firm and pliable base for the three-valve
leaflets and it is in continuity with the aortic and mitral annuli.
The septal portion of the TA is relatively fixed due to its position
between the fibrous trigones. Therefore, as the RV free wall
expands outwards, dilatation of the TA occurs primarily in its
free wall aspect.
The diastolic opening of the valve along with corresponding ex-
pansion of the annulus provides a tricuspid orifice area of 7–9 cm2.
The systolic narrowing of the orifice provides an effective valve
closure; however, a trivial or mild TR is detectable using
Doppler echocardiography in 80–90% of normal subjects.12,13
Pathophysiology of functional
tricuspid regurgitation
While mild FTR is frequent without detectable abnormality of the
valvulo-ventricular complex, the formation of a larger regurgitant
orifice requires a combination of TA dilation and valvular deform-
ation. The analysis of respiratory changes of TR by quantitative
methods has provided important insights in that regard. All types
of TR are characterized by increasing regurgitant orifice during in-
spiration. This enlarged orifice is opposed by a decline in regurgi-
tant gradient (from RV to right atrium) so that the combination of
these opposite changes results in a larger regurgitant volume
during inspiration but with an increase of lesser magnitude than
that of the regurgitant orifice. The increase in regurgitant orifice
area with inspiration is due to a combination of annular enlarge-
ment and valvular tenting.5These two mechanisms variously com-
bined form the basis of all forms of FTR. Those caused by RV
enlargement and dysfunction, that may be primary or secondary
to left heart diseases resulting in pulmonary hypertension, are pre-
dominantly due to valve tenting, while FTR without pulmonary
hypertension is predominantly due to annular enlargement
(Figure 2). These factors explain the fact that while pulmonary ar-
terial hypertension from any cause is known to be associated with
FTR, not all patients with pulmonary hypertension develop signifi-
cant TR. Mutlak et al.14assessed the determinants of TR severity in
2139 patients with pulmonary hypertension. In this population, ele-
vated pulmonary artery systolic pressure was associated with more
severe TR (odds ratio 2.26 per 10 mmHg increase). However, a
large number of patients with elevated pulmonary artery systolic
pressure showed only mild TR (65.4% of patients with moderate
and 45.6% of patients with severe pulmonary hypertension, re-
spectively). Other factors such as atrial fibrillation, pacemaker
leads, and RV remodelling were also significant determinants of
the severity of TR. Among them, the spherical remodelling of
the RV in response to pulmonary hypertension was the most
powerful predictor of FTR.5Idiopathic dilatation of the TA often
Table 1
Aetiology of tricuspid regurgitation
Functional (morphological normal leaflets with annular dilatation)
Left heart diseases (LV dysfunction or valve diseases) resulting in
pulmonary hypertension
Primary pulmonary hypertension
Secondary pulmonary hypertension (e.g. chronic lung disease,
pulmonary thrombo-embolism, left-to-right shunt)
Right ventricular dysfunction from any cause (e.g. myocardial
diseases, ischaemic heart disease)
Atrial fibrillation
Cardiac tumours (particularly right atrial myxomas)
Structural abnormality of the tricuspid valve
Ebstein anomaly
Tricuspid valve dysplasia
Tricuspid valve hypoplasia
Tricuspid valve cleft
Double orifice tricuspid valve
Unguarded tricuspid valve orifice
Endomyocardial fibrosis
Carcinoid disease
Traumatic (blunt chest injury, laceration)
Pace-maker/defibrillator lead interference
Right ventricular biopsy
Drugs (e.g. exposureto fenfluramine-phentermine, or
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Figure 2 Mechanisms of functional or secondary tricuspid regurgitation.
Figure 1 Anatomic specimens showing tricuspid and mitral apparatus anatomy. Red arrows indicate the atrio-ventricular to semilunar valve
distances. Yellow arrows indicate the specific differences between tricuspid and mitral valves. Tricuspid valve apparatus is characterized by mul-
tiple, widely separated papillary muscles which carry chordae to a single tricuspid valve leaflet. Accessory chordal attachments to the right ven-
tricular free wall are also noted (Courtesy of Dr Willam Edwards, Mayo Clinic).
Functional tricuspid regurgitation
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associated with atrial fibrillation can cause FTR, which is sometimes
severe. Furthermore, TA dilatation caused by the volume overload
of FTR in turn causes further separation of leaflets and progression
of FTR. Thus, annular dilatation, RV dilatation or TV tenting, and
not pulmonary hypertension in and by itself are the main determi-
nants of FTR.15
These mechanisms of FTR can persist even after successful cor-
rection of a potentially causal disease (Figure 3). In patients with
chronic pulmonary thrombo-embolic hypertension or mitral sten-
osis, after successful pulmonary thrombo-endarteriectomy or
mitral balloon valvuloplasty, there was no change in TA diameter
after the resolution of pulmonary hypertension.16,17After repair
of ischaemic mitral regurgitation,18TA dilatation also persists and
is associated with late recurrent TR. In addition, TA dilatation is
usually associated with annular flattening (loss of its saddle
shape), which may increase the annulus-to-papillary muscle dis-
tance, altering the normal relationship between TV leaflet, papillary
muscles, and annulus, and increasing TV leaflet tethering.19
Once TR has become significant, progressive RV remodelling
and dysfunction due to chronic volume overload result in papillary
muscle displacement and leaflet tethering, which worsen TR and
lead to further RV dilatation.20Such valvular deformation involves
marked tenting and is frequent in patients with pulmonary hyper-
tension. Post-annuloplasty patients with marked valvular tenting
(Figure 3) may incur aggravation of the tethering if the RV does
not display reverse remodelling. Hence, coaptation height and
tenting area, reflecting TV tethering, are important predictors of
the severity of early residual TR after TV repair.20A preoperative
coaptation height .1.0 cm has been shown to predict a 55%
repair failure immediately after surgery.21An adjunctive procedure
(i.e. anterior leaflet elongation with a pericardial patch) to reduce
leaflet tethering in patients with a coaptation distance .8 mm or a
tenting area .16 mm2has been reported to decrease TR recur-
rence.22,23With three-dimensional echocardiography (3DE), the
extent of TV tethering can be measured in terms of tenting
volume and this parameter has been reported to independently
determine residual TR after tricuspid annuloplasty. A TV tenting
volume .2.3 mL showed a sensitivity of 100% and specificity of
84% to predict severe residual TR after tricuspid annuloplasty.24
Persistently high post-operative RV pressures increase the pro-
gression and severity of residual TR25,26possibly through persist-
ent RV enlargement and dysfunction, with valve tethering.
Occurrence of atrial fibrillation is also a significant factor in the de-
velopment of TR in patients with mitral valve disease.27In these
patients, the increase in left atrial pressure and size causes atrial fib-
rillation that in turn causes right atrial dilatation and further in-
crease in TA enlargement.16,28
Using echocardiography, the Framingham Heart Study investigators
found a prevalence of moderate or severe TR of 0.8% and an
increased prevalence with ageing.12Overall, the prevalence of sig-
nificant TR was 4.3 times greater in women than in men.
Tricuspid regurgitation is frequently present in patients with
mitral valve disease and more than one-third of patients with
mitral stenosis have at least moderate TR.29,30Severe TR has
been reported in 23–37% of patients after mitral valve replace-
ment for rheumatic valve disease.31,32Functional TR is frequently
observed in the advanced stage of left-sided valvular heart
disease or myocardial disease,33but 14% of TR may occur in the
absence of structural TV alterations, pulmonary hypertension, or
left heart dysfunction.31
Finally, the development of haemodynamically significant TR has
been reported in 27% of patients who had only mild TR at the time
of left-sided valve surgery.6In most cases, TR is diagnosed late after
mitral valve replacement, 10 years on average, but can appear as
late as 24 years after the initial surgery.31,32Matsunaga and
Duran18reported moderate or severe TR in 74% of patients
3 years after surgical repair of ischaemic mitral regurgitation.
Assessment of patients with
functional tricuspid regurgitation
Clinical evaluation
The most prominent physical features of TR are those related to
the characteristics of the murmur and to the development of right-
sided congestive heart failure. In the early stages of disease,
patients remain completely asymptomatic or present with fatigue
and shortness of breath before developing overt signs of right-
heart failure. With severe right-sided failure, patients with severe
TR may present with weight loss and cachexia, cyanosis, and jaun-
dice (reflecting hepatic insufficiency). Ascites and peripheral
oedema and even anasarca may be present.
Figure 3 Tricuspid leaflet tethering (arrows) after restrictive
annuloplasty (yellow dotted line) in the presence of severe dila-
tation of right-heart chambers. LA, left atrium; RA, right atrium;
RV, right ventricle.
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Role of imaging techniques
Cardiac catheterization
Before the introduction of 2DE and Doppler echocardiography,
cardiac catheterization was the main imaging modality to confirm
the presence and severity of TR. The diagnosis of TR posed a
greater challenge, as selective angiography into the RV would
often distort the TV and catheter position in the RV would be dif-
ficult to maintain. At present, diagnostic cardiac catheterization
should rarely, if ever, be undertaken for the diagnosis or quantita-
tion of TV disease alone.
Chest X-ray
Chest radiograph is also of limited utility. Cardiomegaly associated
with prominent right-heart borders may be noted, but there are
no specific findings which suggest a diagnosis of TV disease.
Two-dimensional echocardiography combined with spectral and
colour flow Doppler is now the main modality for detection and
quantitation of TR.34'Physiological' FTR is associated with
normal valve leaflet morphology and normal RV and atrial size.
The colour jet is localized in a small region adjacent to valve
closure (usually ,1 cm), is thin, central, and often is limited to
early-systole. However, the precise threshold at which FTR transi-
tions from physiological to abnormal remains uncertain.
When TR is detected by colour Doppler and may be abnormal
or 'pathological' (moderate or more severe), comprehensive de-
scription of leaflet morphology and of the pathophysiological
mechanisms underlying TR is warranted. In such cases, compre-
hensive assessment of the morphology of the valvulo-ventricular
complex using 3DE (Figure 4) may provide important clues regard-
ing aetiology and mechanisms of valve dysfunction.35–38
Functional TR is characterized by TA dilatation (often .40 mm)
and may also involve tethering of the leaflets, with a tenting dis-
tance .8 mm. Tricuspid annulus diameter measured with 2DE
(both measured in four-chamber view and in parasternal short-axis
view) systematically underestimate the actual TA diameter in com-
parison with 3DE and cardiac magnetic resonance (CMR).35,39As a
consequence, 65% of patients with normal TA diameter at 2DE
showed grade 1–2 TR, compared with 30% of patients with
normal TA size at 3DE.40In most severe cases of TA dilation,
central leaflet coaptation may be absent, resulting in wide-open re-
gurgitation (Figure 5).
Colour flow Doppler and spectral Doppler are highly sensitive
for TR detection and generally provide good semi-quantitative as-
sessment of its severity.34Tricuspid regurgitation detection by
colour flow imaging uses parasternal (tricuspid inflow view and
short-axis view at great vessels level), apical, or subcostal (four-
chamber view) approaches. Regurgitant jet area correlates
roughly with TR severity, ,5 cm2in mild, 6–10 cm2in moderate,
and .10 cm2in severe cases. In clinical practice, visual estimate
rather than actual planimetry is the basis of TR severity assessment,
which may participate to the vagueness of the qualitative approach.
Detection of eccentric jets adhering, swirling, and reaching the
posterior wall of the right atrium suggests organic rather than func-
tional TR and thereby a rather voluminous regurgitation. Con-
versely, small thin central jets usually indicate mild TR. Colour
Doppler evaluation of TR, despite its simplicity, is a source of
errors, is limited by technical and haemodynamic factors and
therefore it is not recommended to assess TR severity when it
Figure 4 Visualization of tricuspid valve complex by two- (A–C) and three-dimensional (D–F) echocardiography. Apical four-chamber (A),
right ventricular inflow (B), and subcostal (C) views. Volume rendering with the cropping plane corresponding to apical four-chamber view (D),
allowing a comprehensive visualization of tricuspid leaflets, as well as of subvalvular apparatus, papillary muscles, and moderator band (arrow);
en face view of tricuspid valve from the right ventricle (E) from the right atrium (F). ATL, anterior tricuspid leaflet; PTL, posterior tricuspid
leaflet; STL, septal tricuspid.
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is more than mild.34A more quantitative FTR assessment is pro-
vided by vena contracta width and proximal isovelocity surface
area (PISA) measurements.
Vena contracta represents the cross-sectional area of the blood
column as it leaves the regurgitant orifice; it thus reflects the regur-
gitant orifice area. The vena contracta of the TR flow is typically
imaged in the apical four-chamber view using a careful probe angu-
lation to optimize the flow image, an adapted Nyquist limit (colour
Doppler scale, 40–70 cm/s) to identify with clarity the neck of the
jet, and a narrow sector scan coupled with the zoom mode to
maximizetemporal resolution
(Figure 6).41Averaging measurements over at least 2—3 beats is
recommended. Vena contracta width .6.5 mm is usually asso-
ciated to severe TR. Intermediate values are not accurate for dis-
tinguishing moderate from mild TR. A limitation of measuring vena
contracta width is the fact that regurgitant orifice geometry is
complex and not necessarily circular (Figure 6). This may explain
the limited correlation between vena contracta width by 2D
colour Doppler and 3DE planimetry of effective regurgitant
orifice area. Particular caution should be used in assessing eccen-
tric jets. With 3DE colour Doppler, planimetered regurgitant
orifice area .75 mm2has been associated with severe TR.42
Proximal isovelocity surface area radius measurement is by itself
a good indicator of severity of regurgitation, but complete applica-
tion of the method is preferable to obtain physiological informa-
tion on TR. The apical four-chamber view and the parasternal
long- and short-axis views are classically recommended for an
optimal visualization of the PISA. The area of interest is optimized
by reducing imaging depth and Nyquist limit to ?10–20% of the
peak velocity of the FTR jet. The PISA radius is measured at mid-
systole using the first aliasing. Qualitatively, a TR PISA radius
.9 mm at a Nyquist limit of 28 cm/s has been associated with
the presence of significant TR (corresponding to an effective regur-
gitant orifice area ≥40 mm2and a regurgitant volume ≥45 mL, the
quantitative thresholds for severe TR), whereas a radius ,5 mm
suggests mild regurgitation. However, the PISA method also
faces several limitations.43Eccentric jets may represent a challenge
in alignment with the beam of ultrasound. The most challenging
issue is the fact that leaflets that are tenting are often not flat
and the outer angle formed by these should be accounted for in
the calculation of regurgitant flow. It is also crucial to account
for the expected respiratory variation of TR and to average mea-
surements performed during inspiration (largest flow convergence,
lowest TR velocity) and expiration (smallest flow convergence,
highest TR velocity) to provide an average severity over the re-
spiratory cycle to the clinician (Figure 7).5Finally, we have to
take into account the extreme load dependency of the tricuspid
regurgitant volume. Changes in patient's position and diuretic
therapy are among the most frequent causes of inter-technique
and day-to-day variability of severity of TR.15
Tricuspid regurgitation jet velocity reflects the pressure gradient
between the RV and the right atrium throughout systole. The
shape of the TR velocity profile using continuous-wave Doppler
provides a clue to TR severity. The regurgitation profile is generally
parabolic except in severe cases, where high right atrial 'C–V'
waves result in a rapid equalization with RV pressure, resulting in
a rapid deceleration of the Doppler tracing, also described as the
'V' wave cut-off sign (Figure 7).
Additionalindirect clues ofregurgitationseverityare thedensityof
doxicalinterventricularseptalmotionandthe systolicbulgeofintera-
trial septum towards the left atrium. In severe FTR, hepatic venous
systolic flow reversal is a specific but relatively insensitive sign.
In clinical practice, Doppler echocardiographic assessment of TR
integrates all signs and measurements obtained by all methods
(Table 2).
Finally, a comprehensive echocardiographic assessment of
patients with FTR should include measurement of RV size and
function. Two-dimensional echocardiography quantitation of RV
size and function is challenging, due to the anterior position of
the RV in the chest, its complex asymmetric geometry, irregularity
of the highly trabeculated endocardial border, impossibility to visu-
alize in the same view both inflow and outflow tracts, and lack of
realistic geometric models to use for volume quantitation.44Three-
dimensional echocardiography has been demonstrated to have a
good accuracy in measuring RV volumes compared with CMR.45
Cardiac magnetic resonance
In the absence of specific contraindications, when echocardio-
graphic imaging is limited by a suboptimal acoustic window, in
Figure 5 Severe functional tricuspid regurgitation due to marked enlargement and dysfunction of the right ventricle. Four-chamber view,
showing a large tricuspid annulus with non-coapting leaflets, severe tenting, and severe tricuspid regurgitation (A) with a measured vena con-
tracta of 12 mm (red arrow). Three-dimensional volume rendering of tricuspid valve from ventricular (B) and atrial (C) perspectives, showing
thickened, non-coapting leaflets with a large central regurgitant orifice in systole.
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patients with equivocal echocardiographic findings and when 3DE
is not available for assessing RV volumes and function, CMR is the
technique of choice to assess patients with significant TR.46
Cardiac magnetic resonance is not limited by acoustic window
and can image the whole heart in any plane providing excellent
myocardial definition. Cardiac magnetic resonance is currently
the gold standard for the assessment of RV morphology and func-
tion, and accurate assessment of the RV is crucial to understand
the underlying mechanisms and address management in patients
with TR even if no threshold value of RV volume has been vali-
dated by its prognostic value with regard to TR. Anwar et al.39
have used CMR to assess the configuration of TA.
Indications and timing of tricuspid
valve surgery
In the absence of clinical trials, present guidelines are based on
expert opinions. Our practice has evolved to include more surgical
treatment of FTR even when it is isolated. The principles guiding
surgical indications are as follows:
(A) The surgical indication for FTR is considered more actively if:
(i) another cardiac operation is considered, whether it is for
valve surgery, coronary bypass, or MAZE procedure;
(ii) the FTR is severe, particularly based on quantitative criteria
with ERO ≥ 40 mm2;
(iii) the patient is symptomatic from the TR and there are con-
gestive signs directly related to the TR (enlarged pulsatile
liver, with pulsatile jugular veins and systolic reversal in the
hepatic veins by echo-Doppler). In the absence of congestive
signs, marked reduction of functional capacity measured by
exercise testing and without other cause than the TR is essen-
tial to consider surgery;
(iv) the comorbid conditions are not overwhelming and life ex-
pectancy is of at least several years.
Thus, for example, it is reasonable to consider correction of a
moderate TR without congestion if mitral valve regurgitation
requires repair or to consider surgery for severe idiopathic FTR
in the context of long-standing atrial fibrillation, with marked right-
sided congestion. Conversely, it is less enticing to consider surgery
for severe FTR with supra-systemic primary pulmonary hyperten-
sion. In any case, patients should be referred for surgery before
developing secondary liver cirrhosis or severe RV dysfunction
sincetheseconditionsidentifya veryhigh-risksurgical
Figure 6 Three-dimensional echocardiographic visualization of the complex geometry of the regurgitant orifice in functional tricuspid regur-
gitation. Volume rendering of the tricuspid valve at mid-systole from the atrial perspective showing the regurgitant orifice (A). The elliptical
shape of the regurgitant orifice at colour Doppler (B) is displayed along with the two longitudinal cut planes of the regurgitant jet in apical
four-chamber (yellow panel, C) and its orthogonal view (red panel, D). Vena contracta measured in C is significantly smaller than in D.
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population.47There is increasing evidence that patients undergoing
mitral valve surgery would benefit from tricuspid annuloplasty
when the TA is dilated independent on the severity of TR.6,48,49
(B) The type of surgery performed is dependent on the morph-
ology of the FTR:
(i) if the FTR is purely due to annular enlargement without tenting
and the RV function is normal, usually annuloplasty is
(ii) if tenting is the main mechanism of FTR and/or RV dysfunction
may not be reversible post-operatively, annuloplasty may be
Figure 7 Quantification of regurgitation severity by PISA method in a patient with severe functional tricuspid regurgitation. Both colour
Doppler images (A and B) and continuous-wave Doppler tracings of regurgitant jet (C) show high respiratory variability stressing the need
to average measurements performed during inspiration (largest flow convergence, lowest TR velocity) and expiration (smallest flow conver-
gence, highest TR velocity) to provide an average severity over the respiratory cycle. The severity of the tricuspid regurgitation is also
shown by the continuous Doppler signals of relatively low-amplitude, with 'cut-off' sign (white arrow).
Tricuspid valve morphologyNormal/abnormalNormal/abnormal
Colour flow TR jetSmall, centralIntermediate
CW signal of TR jet Faint/parabolicDense/parabolic
VC width (mm)Not defined
PISA radius (mm)
Hepatic vein flowSystolic dominance Systolic blunting
Tricuspidinflow NormalNormal
EROA (mm2) Not definedNot defined
R Vol (ml)Not defined Not defined
+ RA/RV/IVC dimension
Table 2
Echocardiographic assessment of tricuspid regurgitation severity (modified from Lancellotti et al.34)
Parameters MildModerateSevere
Abnormal/flail/large coaptation defect
Very large central jet or eccentric wall impinging jet
Dense/triangular with early peaking (peak , 2 m/s in massive TR)
Systolic flow reversal
E wave dominant (≥1 cm/s)
CW,continuous-wave Doppler; EROA, effectiveregurgitant orifice area;PISA, proximalisovelocitysurfacearea;RA, right atrium;RV,right ventricle; RVol,regurgitantvolume;TR,
tricuspid regurgitation; VC, vena contracta.
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Class IBTV repair is beneficial for severe TR in patients with MV disease
requiring MV surgery
Class IC
Table 3
managing patients with tricuspid regurgitation
Comparison of American College of Cardiology/European Society of Cardiology clinical guidelines for
ACC/AHA guidelines50
ESC/EACTS guidelines51
Severe TR in a patient undergoing left-sided valve surgery
Severe organic TR and symptoms despite medical therapy without
severe right ventricular dysfunction
Moderate organic TR in a patient undergoing left-sided valve surgery Class IIaC TV replacement or annuloplasty is reasonable for severe primary
TR when symptomatic
TV replacement is reasonable for severe TR secondary to
diseased/abnormal TV leaflets not amenable to annuloplasty
or repair
Mild-to-moderate secondary TR with dilated annulus (.40 mm or
21 mm/m2) in a patient undergoing left-sided valve surgery
Severe TR and symptoms, after left-sided valve surgery, in the
absence of left-sided myocardial, valve, or right ventricular
dysfunction and without severe pulmonary hypertension (systolic
pulmonary artery pressure .60 mmHg)
Severe isolated TR with mild or no symptoms and progressive
dilatation or deterioration of right ventricular function
Class IIbCTricuspid annuloplasty may be considered for less than severe TR in
patients undergoing MV surgery when there is pulmonary
hypertension or tricuspid annular dilatation.
TV replacement or annuloplasty is not indicated in asymptomatic
patients with TR whose pulmonary artery systolic pressure is
60 mmHg in the presence of normal MV
TV replacement orannuloplasty is notindicated in patients with mild
organic TR
Class III
MV, mitral valve; TR, tricuspid regurgitation; TV, tricuspid valve.
Figure 8 American College of Cardiology/American Heart Association50and the European Society of Cardiology51guideline-based algorithm
for the management of tricuspid regurgitation in patients who have not previously undergone left-sided valve surgery. RV, right ventricular.
Functional tricuspid regurgitation
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associated with excess recurrence of TR24and either valve re-
placement or elongation of anterior leaflet tissue by pericardial
patches may be necessary.
Table 3 summarizes the indications for the management of signifi-
cant TR from the American College of Cardiology/American Heart
Association (ACC/AHA)50and the European Society of Cardi-
ology (ESC/EACTS).51Patient's clinical status, concomitant left-
sided valve surgery, and the aetiology of TR usually determine
the appropriate therapeutic strategy in each individual case
(Figures 7 and 8).
Assessment of FTR is challenging due to the complex anatomy of
both the TV and the RV. However, identification of the mechanism
of regurgitation, reliable grading of its severity, accurate quantita-
tive data about extent of TV tethering, TA dilatation, and RV en-
largement are crucial for selecting patients who may benefit of
early surgical repair and tailor the intervention in order to avoid
progression to right-heart failure.
Finally, a better understanding of FTR pathophysiology and
anatomy will provide the bases for developing percutaneous pro-
cedures to treat TR in high-risk surgical candidates.52
1. Nath J, Foster E, Heidenreich PA. Impact of tricuspid regurgitation on long-term
survival. J Am Coll Cardiol 2004;43:405–409.
2. Mutlak D, Lessick J, Reisner SA, Aronson D, Dabbah S, Agmon Y.
Echocardiography-based spectrum of severe tricuspid regurgitation: the fre-
quency of apparently idiopathic tricuspid regurgitation. J Am Soc Echocardiogr
3. Staab ME, Nishimura RA, Dearani JA. Isolated tricuspid valve surgery for severe
tricuspid regurgitation associated with left-sided valvular disease. J Heart Valve
Dis 1999;8:567–574.
4. King RM, Schaff HV, Danielson GK, Gersh BJ, Orszulak TA, Piehler JM, Puga FJ,
Pluth JR. Surgery for tricuspid regurgitation late after mitral valve replacement. Cir-
culation 1984;70:I193–I197.
5. TopilskyY,TribouilloyC,Michelena
Enriquez-Sarano M. Pathophysiology of tricuspid regurgitation. Quantitative
Doppler echocardiographic assessment of respiratory dependence. Circulation
6. Dreyfus GD, Corbi PJ, Chan KM, Bahrami T. Secondary tricuspid regurgitation or
dilatation: which should be the criteria for surgical repair? Ann Thorac Surg 2005;
7. Chan V, Burwash IG, Lam BK, Auyeung T, Tran A, Mesana TG, Ruel M. Clinical
and echocardiographic impact of functional tricuspid regurgitation repair at the
time of mitral valve replacement. Ann Thorac Surg 2009;88:1209–1215.
8. Lee JW, Song JM, Park JP, Lee JW, Kang DH, Song JK. Long-term prognosis of iso-
lated significant tricuspid regurgitation. Circ J 2010;74:375–380.
9. McCarthy PM, Sales VL. Evolving indications for tricuspid valve surgery. Curr Treat
Opin Cardiovasc Med 2010;12:587–597.
10. Simon R. Size and motion of the tricuspid annulus. Circulation 1983;67:709.
11. Fukuda S, Saracino G, Matsumara Y, Daimon M, Tran H, Greenberg NL,
Hozumi T, Yoshikawa J, Thomas JD, Shiota T. Three-dimensional geometry of
the tricuspid annulus in healthy subjects and in patients with functional tricuspid
regurgitation: a real-time, 3-dimensional echocardiographic study. Circulation 2006;
12. Singh JP, Evans JC, Levy D, Larson MG, Freed LA, Fuller DL, Lehman B,
Benjamin EJ. Prevalence and clinical determinants of mitral, tricuspid, and aortic
regurgitation (the Framingham Heart Study). Am J Cardiol 1999;83:897–902.
13. Klein A, Burstow D, Tajik A, Zachariah P, Taliercio C, Taylor C, Bailey K, Seward J.
Age-related prevalence of valvular regurgitation in normal subjects: a comprehen-
sive color-flow examination in 118 volunteers. J Am Soc Echocardiogr 1990;3:
14. Mutlak D, Aronson D, Lessick J, Reisner SA, Dabbah S, Agmon Y. Functional tri-
cuspid regurgitation in patients with pulmonary hypetension: is pulmonary artery
pressure the only determinant of regurgitation severity? Chest 2009;135:115–121.
15. Sagie A, Schwammenthal E, Padial LR, Vazquez de Prada JA, Weyman AE,
Levine RA. Determinants of functional tricuspid regurgitation in incomplete tri-
cuspid valve closure: Doppler color flow study of 109 patients. J Am Coll Cardiol
16. Song H, Kang DH, Kim JH, Park KM, Song JM, Choi KJ, Hong MK, Chung CH,
Song JK, Lee JW, Park SW, Park SJ. Percutaneous mitral valvuloplasty versus sur-
gical treatment in mitral stenosis with severe tricuspid regurgitation. Circulation
17. Sadeghi HM, Kimura BJ, Raisinghani A, Blanchard DG, Mahmud E, Fedullo PF,
Jamieson SW, De Maria AN. Does lowering pulmonary arterial pressure eliminate
severe functional tricuspid regurgitatin? Insights from pulmonary thromboendoar-
terectomy. J Am Coll Cardiol 2004;44:126–132.
18. Matsunaga A, Duran CM. Progression of TR after repaired functional ischemic
mitral regurgitation. Circulation 2005;112(Suppl):I-453–I-457.
19. Ton-Nu TT, Levine RA, Handschumacher MD, Dorer DJ, Yosefy C, Fan D, Hua L,
Jiang L, Hung J. Geometric determinants of functional tricuspid regurgitation:in-
sights from 3-dimensional echocardiography. Circulation 2006;114:143–149.
20. Fukuda S, Song JM, Gillinov AM, McCarthy PM, Daimon M, Kongsaerepong V,
Thomas JD, Shiota T. Tricuspid valve tethering predicts residual tricuspid regur-
gitation after tricuspid annuloplasty. Circulation 2005;111:975–979.
21. Fukuda S, Gillinov AM, McCarthy PM, Matsumura Y, Thomas JD, Shiota T. Echo-
cardiographic follow-up of tricuspid annuloplasty with a new three-dimensional
ring in patients with functional tricuspid regurgitation. J Am Soc Echocardiogr
22. Roshanali F, Saidi B, Mandegar MH. Echocardiographic approach to the decision-
making process for tricuspid valve repair. J Thorac Cardiovasc Surg 2010;139:
23. Raja SG, Dreyfus G. Basis for intervention on functional tricuspid regurgitation.
Semin Thorac Cardiovasc Surg 2010;22:79–83.
24. Min SY, Song JM, Kim JH, Jang MK, Kim YJ, Song H, Kim DH, Lee JW, Kang DH,
Song JK. Geometric changes after tricuspid annuloplasty and predictors of residual
tricuspid regurgitation: a real-time three-dimensional echocardiography study. Eur
Heart J 2010;31:2871–2880.
25. Fukuda S, Gillinov AM, McCarthy PM, Stewart WJ, Song JM, Kihara T, Daimon M,
Shin MS, Thomas JD, Shiota T. Determinants of recurrent or residual functional
26. De Bonis M, Lapenna E, Sorrentino F, La Canna G, Grimaldi A, Maisano F,
Torracca L, Alfieri O. Evolution of tricuspid regurgitation after mitral valve
repair for functional mitral regurgitation in dilated cardiomyopathy. Eur J Cardi-
othorac Surg 2008;33:600–606.
27. Matsuyama K, Matsumoto M, Sugita T, Nishizawa J, Tokuda Y, Matsuo T. Predic-
tors of residual tricuspid regurgitation after mitral valve surgery. Ann Thorac Surg
28. Kim HK, Kim YJ, Kim KI, Jo S, Kim KB, Ahn H, Sohn DW, Oh BH, Lee MM,
Park YB, Choi YS. Impact of the maze operation combined with left-sided valve
surgery on the change in tricuspid regurgitation over time. Circulation 2005;112:
29. Sagie A, Freitas N, Chen MH, Marshall JE, Weyman AE, Levine RA. Echocardio-
graphic assessment of mitral stenosis and its associated valvular lesions in 205
patioents and lack of association with mitral valve prolapse. J Am Soc Echocardiogr
30. Boyaci A, Gokce V, Topaloglu S, Korkmaz S, Goksel S. Outcome of significant
functional tricuspid regurgitation late after mitral valve replacement for predom-
inant rheumatic mitral stenosis. Angiology 2007;58:336–342.
31. Izumi C, Iga K, Konishi T. Progression of isolated tricuspid regurgitation late after
mitral valve surgery for rheumatic mitral valve disease. J Heart Valve Dis 2002;11:
32. Porter A, Shapira Y, Wurzel M, Sulkes J, Vaturi M, Adler Y, Sahar G, Sagie A. Tri-
cuspid regurgitation late after mitral valve replacement: clinical and echocardio-
graphic evaluation. J Heart Valve Dis 1999;8:57–62.
33. Bruce CJ, Connolly HM. Right-sided valve diseases deserves a little more respect.
Circulation 2009;119:2726–2734.
34. Lancellotti P, Moura L, Pierard LA, Agricola E, Popescu BA, Tribuilloy C,
Hagendorff A, Monin JL, Badano LP, Zamorano JL. European Association of Echo-
cardiography recommendations for the assessmento of valvular regurgitation.
Part 2: mitral and tricuspid regurgitation (native valve diseases). Eur J Echocardiogr
35. Badano LP, Agricola E, Perez de Isla L, Gianfagna P, Zamorano JL. Evaluation of the
tricuspid valve morphology and function by transthoracic real-time three-
dimensional echocardiography. Eur J Echocardiogr 2009;10:477–484.
36. Muraru D, Badano LP. Assessment of tricuspid valve morphology and function. In:
Badano LP, Lang RM, Zamorano JL (eds), Textbook of Real-Time Three Dimensional
Echocardiography. London: Springer; 2011, p173–182.
L.P. Badano et al.
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37. Muraru D, Badano LP, Sarais C, Solda E, Iliceto S. Evaluation of tricuspid valve
morphology and function by transthoracic three-dimensional echocardiography.
Curr Cardiol Rep 2011;13:242–249.
38. Lang RM, Badano LP, Tsang W, Adams DH, Agricola E, Buck T, Faletra FF,
Franke A, Hung J, de Isla LP, Kamp O, Kasprzak JD, Lancellotti P, Marwick TH,
McCulloch ML, Monaghan MJ, Nihoyannopoulos P, Pandian NG, Pellikka PA,
Pepi M, Roberson DA, Shernan SK, Shirali GS, Sugeng L, Ten Cate FJ,
Vannan MA, Zamorano JL, Zoghbi WA. EAE/ASE recommendations for image ac-
quisition and display using three-dimensional echocardiography. Eur Heart J Cardi-
ovasc Imaging 2012;13:1–46.
39. Anwar AM, Soliman OI, Nemes A, van Geuns RJ, Geleijnse ML, Ten Cate FJ. Value
of assessment of tricuspid annulus: real-time three-dimensional echocardiography
and magnetic resonance imaging. Int J Cardiovasc Imaging 2007;23:701–705.
40. Anwar AM, Geleijnse ML, Ten Cate FJ, Meijboom FJ. Assessment of tricuspid
valve annulus size, shape and function using real-time three-dimensional echocar-
diography. Interact Cardiovasc Thorac Surg 2006;5:683–687.
41. Tribouilloy C, Enriquez-Sarano M, Bailey K, Tajik A, Seward J. Quantification of
tricuspid regurgitation by measuring the width of the vena contracta with
Doppler color flow imaging: a clinical study. J Am Coll Cardiol 2000;36:472–478.
42. Velayudhan DE, Brown TM, Nanda NC, Patel V, Miller AP, Mehmood F, Rajdev S,
Fang L, Frans EE, Vengala S, Madadi P, Yelamanchili P, Baysan O. Quantification of
tricuspid regurgitation by live three-dimensional transthoracic echocardiographic
measurements of vena contracta area. Echocardiography 2006;23:793–800.
43. Mascherbauer J, Maurer G. The forgotten valve: lessons to be learned in tricuspid
regurgitation. Eur Heart J 2010;31:2841–2843.
44. Badano LP, Ginghina C, Easaw J, Muraru D, Grillo MT, Lancellotti P, Pinamonti B,
Coghlan G, Marra MP, Popescu BA, De Vita S. Right ventricle in pulmonary arter-
ial hypertension: haemodynamics, structural changes, imaging, and proposal of a
study protocol aimed to assess remodelling and treatment effects. Eur J Echocar-
diogr 2010;11:27–37.
45. Shimada YJ, Shiota M, Siegel RJ, Shiota T. Accuracy of right ventricular volumes
and function determined by three-dimensional echocardiography in comparison
with magnetic resonance imaging: a meta-analysis study. J Am Soc Echocardiogr
46. Kim H-K, Kim Y-J, Park E-A, Bae J-S, Lee W, Kim K-H, Kim K-B, Sohn DW, Ahn H,
Park J-H, Park Y-B. Assessment of hemodynamic effects of surgical correction of
severe functional tricuspid regurgitation: cardiac magnetic resonance imaging
study. Eur Heart J 2010;31:1520–1528.
47. Arif R, Seppelt P, Scwill S, LKoljic D, Ghodsizad A, Ruhparwar A, Karck M,
Kallenbach K. Predictive risk factors for patients with cirrhosis undergoing
heart surgery. Ann Thorac Surg 2012;94:1947–1952.
48. van de Veire NR, Braun J, Delgado V, Versteegh MI, Dion RA, Klautz RJ, Bax JJ.
Tricuspid annuloplasty prevents right ventricular dilatation and progression of tri-
cuspid regurgitation in patients with tricuspid annular dilatation undergoing mitral
valve repair. J Thorac Cardiovasc Surg 2011;141:1431–1439.
49. Benedetto U, Melina G, Angeloni E, Refice S, Roscitano A, Comito C,
Sinatra R. Prophylactic tricuspid annuloplasty in patients with dilated tricuspid
annulus undergoing mitral valve surgery. J Thorac Cardiovasc Surg 2012;143:
50. Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DP, Freed MD,
Gaasch WH, Lytle BW, Nishimura RA, O'Gara PT, O'Rourke RA, Otto CM,
Sha PM, Shanewise JS. 2008 focused update incorporated into the ACC/AHA
2006 guidelines for the management of patients with valvular heart disease: a
report of the American College of Cardiology/American Heart Association
Task Force on Practice Guidelines (Writing Committee to revise the 1998 guide-
lines for the management of patients with valvular heart disease). Endorsed by the
Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiog-
raphy and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol
51. Vahanian A, Alfieri O, Andreooti F, Antunes M, Baro ´n- Esquivias G,
Baumgartner H, Borger MA, Carrel TP, De Bonis M, Evangelista A, Falk V,
Iung B, Lancellotti P, Pierard L, Price S, Schaefers H-J, Schuler G, Stepinska J,
Swedberg K, Takkenberg J, Von Oppel UO, Windecker S, Zamorano JL,
Zembala M. Guidelines on the Management of Valvular Heart Disease (Version
2012). Eur Heart J 2012;33:2451–2496.
52. Rogers JH, Bolling SF. The tricuspid valve: current perspective and evolving man-
agement of tricuspid regurgitation. Circulation 2009;119:2718–2725.
Functional tricuspid regurgitation
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a piacere
|How Do You Say "a piacere"?
a piacere
|Audio Examples and Explanations
|What is "a piacere"?
'A piacere' is a menu term that literally means 'to your liking', or more accurately translated, 'to taste'.
'Piacere' is the Italian verb for 'to like', and is extensively used in many contexts. You will often hear Italians say 'piacere' by itself in the sense of 'it's a pleasure', or 'with pleasure'.
You find 'a piacere' on a menu regarding, for example, steak, which is cooked 'a piacere' depending on whether you like it rare, or medium etc.
a piacere
ah pyah/TCHEHR/reh
With Italian you pronounce each syllable. The stress is on the penultimate (second to last) syllable.
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Candace Calloway Whiting
Candace Calloway Whiting has studied and trained dolphins, seals, and orca whales. She is currently a volunteer at the Center for Whale Research at Friday Harbor.
SeaWorld's Battle With The Government – Check 'The Orca Project' for Background Information and Updates
If you have not yet discovered The Orca Project, now is a great time to visit their website: "Since its inception in 2010, The Orca Project has collaborated with some of the world's top marine mammal experts, caring professionals and individuals from diverse backgrounds to cover the debate on orca captivity, the death of […] [Read More]
SeaWorld Shows Signs of Evolving Away From Its Circus Theme
There are some positive signs emerging from SeaWorld that it is moving in new directions, trying to keep pace with a changing world. The public is increasingly turning away from circus shows, and with the hot water surrounding SeaWorld at the moment over the death of trainer Dawn Brancheau last year, SeaWorld may have to […] [Read More]
New Dolphin Species Identified in Australia; 'Large Sea Fish of the Porpoise Kind'
A newly identified dolphin species has been given the aboriginal name of 'burrunan dolphin', which means "large sea fish of the porpoise kind' in several aboriginal languages. Its scientific name is 'Tursiops australis'. This dolphin is not a new species in an evolutionary sense, it has been living and playing in a few limited spots […] [Read More]
A Whale a World Away in Distress – Sleepless in Tiny Tank, and the Clock is Ticking
Whales and dolphins never sleep, at least not the way we do. They have brief quiet periods of semi-alert consciousness, but there are no quiet hours of reprieve from boredom, stress, or grief. And most baby dolphins (including orcas), can't stop swimming, at all, until they build enough blubber to provide buoyancy and warmth*. In […] [Read More]
Young Orca Whale 'Talks' to Boat: What Would You Say If You Could Communicate With Dolphins?
Whether or not it is a good idea to communicate with dolphins is something I've personally struggled with for most of my life, and yesterday was no different as I struggled to write this post. Everything went wrong, from technical difficulties to brain freezes on my part, so I finally took down the original version. […] [Read More]
SeaWorld, Japan, and the Harderwijk Dolphinarium Linked in International Whale Exploitation Since the 1980′s
This video segment, taken from the feature length documentary "A Fall From Freedom" illustrates the way that marine amusement parks have skirted regulations for decades and continue to thumb their noses at regulations designed to protect wildlife. SeaWorld is documented to have obtained whales from the brutal capture in Japan (see previous post), and then […] [Read More]
Violent Dolphin Capture Caught On Video
(Update of a previous post) The capture of the Southern Resident orca L-pod member, now known as "Lolita" and living at the Miami Seaquarium, was a horrifying event in which several of her family members were killed, their stomachs slit, filled with rocks, and the bodies allowed to sink. Those readers who follow this blog […] [Read More]
Young Orca's Future Hangs In Balance Today – Follow On Twitter @orkacoalitie (Updated)
Update 9/9/11 2pm: "It has been a very long and drawn-out day today as were at the appeal hearing in the orca Morgan case. We can't disclose full details at this moment as this might implicate on our legal steps but we can assure you that another step, albeit small, has been taken in the […] [Read More]


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Freeze-Tag - Fall in Love
Artist: Freeze-Tag
Producer: Freeze-Tag
Album: Eskimo EP
Avg Rating: 3.0 ( 2 votes )
Back in November of 2012, Cleveland electro-dance buzzmaker Freeze-Tag introduced himself to the Booth with an ethereal cover version of Little Dragon's Twice. Though the intervening months have seen the beatsmith/singer lend his guest vocals to Baker's Flu Game, freshly-released promo single Fall in Love marks his first original cut to hit our front page, as well as his first solo feature of 2013. Here, Freeze's intricate drum programming and polyrhythmic synth riffs back reverb-drenched, multi-tracked reflections on the romantic possibilities in his future. Balancing complexity with texture, this cut feels simultaneously chaotic and soothing. For more fresh, eclectic synth soundscapes, check out Freeze's Eskimo EP, available for digital purchase as of April 19.
Freeze-Tag DownloadsR&B/PopIndieAlternative
Written by richard on 06/4/13
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Field Day Recordings
First DJ Booth Appearance:
"Twice" (2012)
Total DJ Booth Features:
3 Songs
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Leviton 5325-W Decora Duplex Receptacle, Quickwire Outlet Push-In, White
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The Leviton 5325-W Decora Duplex Receptacle is a 15 Amp, 125 Volt electrical outlet that easy to install and offers you two wiring options. You can use the standard side-terminals or use Levitons Quickwire feature on the back. With Quickwire you simply push your wire in and it is automatically grasped by a spring mechanism assuring a good connection. The Leviton Decora outlet will match perfectly with other Decora products.
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- High Quality Residential Grade Outlet
- Quick Wire Push-In Accepts No. 14 AWG Copper Wire ONLY
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- Zinc Plated Steel Mounting Strap
- White
- 15 Amp
- 125 Volt
- Body Material: Thermoplasticbr
- Flammability Rating Of V-2 per UL94
- Grounding
- Grounding Screw of Steel 8-32
- Pole: 2
- Wire: 3
- Standards and Certifications: UL/CSA
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Leviton Electrical Outlet, Decora Plus Duplex Receptacle 20A, Commercial Grade - White


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'Extremely affordable sub-$300 price, Sleek design and solid construction'
'Inexpensive, Bright colorful screen, Lightweight, Responsive keyboard, Attractive design'
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'11.6-inch beauty has a very tempting price'
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Park Hyatt Washington
Park Hyatt Washington is located in the trendy West End neighborhood of downtown Washington, D.C. The Potomac River and the shopping, dining and entertainment of Georgetown are three blocks from the hotel. The White House, National Mall and United States Capitol are within three miles. Ronald Reagan Washington National Airport is five miles away. The Foggy Bottom/George Washington University Metro Station is less than one-half mile from the hotel. The Metro offers transportation service throughout the Washington, D.C. area.
Hotel Features.
The 10-story red brick hotel blends modern design with Shaker-style elements. Glass sculptures, natural wooden floors and contemporary art by Picasso, Kenneth Noland and Joan Miro continue the hotel's theme. Blue Duck Tavern, the hotel's on-site restaurant, serves slow-roasted dishes in a contemporary tavern setting. An open kitchen and wood-burning oven add to the restaurant's atmosphere. A cook-to-order breakfast is served daily and more than 50 rare and limited production teas are available at the hotel's Tea Cellar. Additional amenities include a 24-hour business center, complimentary wired and wireless Internet access, computer station, exhibit space, audio-visual equipment, as well as translation services and technology support staff. The hotel features a 24-hour fitness center, and health club. A sky-lit, heated indoor pool, steam room, and spa tub are on-site. The Spa Room offers treatments inculding scented mud masques, cleansing facials, or full body massages. Hair care, manicures and pedicures are also available at Park Hyatt Washington's 1201 Salon.
Guestrooms at the Park Hyatt Washington are decorated in muted earth tones with wooden blinds and authentic folk art. Beds feature Frette linens, pillowtop mattresses, and down duvets. Marble bathrooms include rain showers, bathrobes and complimentary toiletries by Parisian perfumer Blaise Mautin. Laptop-compatible safe, 40-inch high-definition flat-screen TV with premium movie channels, iPod docking station, clock radio, and complimentary wired and wireless (high-speed) Internet access are provided. Room service is available 24-hours a day. Guestrooms are all non-smoking (a $250 fine applies). Fully accessible rooms with roll-in showers are available for disabled guests.
I anjoyed the hotel overall. Everyone was pleasant.
Great people! Good food, but no lunch on Saturday-only brunch- so we ate lunch in our…
Enter dates to check prices
Hotel Info: 866-539-8117from $299
- Junior Suite, 1 King Bed
- Ambassador Ste 1 Kng
- Park, Deluxe Twin Room, 2 Single Beds
- Park, Deluxe Room, 1 King Bed
- Deluxe Room, 2 Double Beds
- Executive Suite, 1 King Bed, Park View
- One king
- Park Executive Suite 1 King
Recommended hotels
At a glance
Key facts
Hotel size
- This hotel has 216 rooms
- This hotel is arranged over 10 floors
- Check-in time starts at 3 PM
- Check-out time is noon
- Express check-in/out
Required at check in
- Credit card or cash deposit required
- Government-issued photo ID required
- Minimum check-in age is 18
Travelling with others
- Children (17 years old and younger) stay free when occupying the parent or guardian's room, using existing bedding
- Babysitting/childcare *
- Pets allowed (dogs and cats only) *
Extra people
- Roll-away beds available, charges may apply*
- Free WiFi in public areas
- Free WiFi and wired Internet access in rooms
- Valet parking *
- Accessible parking
In the hotel
- In-room childcare (surcharge)
- Supervised childcare/activities (surcharge)
- Full breakfast daily (surcharge)
- Restaurant
- Bar/lounge
- 24-hour room service
- Coffee/tea in the lobby
- Indoor pool
- 24-hour fitness facilities
- Full-service spa
- Spa treatment room(s)
- Spa tub
- Steam room
- 24-hour business center
- Number of meeting rooms - 7
- Conference space
- Meeting rooms
- Conference space size (feet) - 12000
- Conference space size (meters) - 1115
- Conference center
- Computer station
- 24-hour front desk
- Concierge services
- Tours/ticket assistance
- Limo or Town Car service available
- Dry cleaning/laundry service
- Free newspapers in lobby
- Luggage storage
- Wedding services
- Number of buildings/towers - 1
- Year Built 1986
- Elevator/lift
- ATM/banking
- Safe-deposit box at front desk
- Designated smoking areas (fines apply)
- Terrace
- Disabled parking
- Accessible path of travel
- Braille or raised signage
- Accessible bathroom
- In-room accessibility
- Roll-in shower
In the room
- Climate control
- Minibar
- Espresso maker
- Coffee/tea maker
- Bathrobes
- Slippers
- Iron/ironing board
- Hypo-allergenic bedding available
- Down comforter
- Blackout drapes/curtains
- Soundproofed rooms
- Turndown service
- Premium bedding
- Pillowtop mattress
- In-room massage available
- Separate sitting area
- Private bathroom
- Deep soaking bathtub
- Rainfall showerhead
- Designer toiletries
- Hair dryer
- 40-inch flat-screen TV
- Pay movies
- Premium TV channels
- IPod docking station
- Desk
- Free newspaper
- Free WiFi
- Free local calls
- Free bottled water
- Daily housekeeping
- In-room safe (laptop compatible)
- Connecting/adjoining rooms available
Special features
DiningBlue Duck Tavern - This restaurant specializes in American cuisine and serves breakfast, brunch, lunch, and dinner. Guests can order drinks at the bar and enjoy alfresco dining (weather permitting). A children's menu is available.
On Site
- Spa tub
- Steam room
- Bicycle rentals on site
- Free bicycles on site
- Golfing nearby
- Hiking/biking trails nearby
- Kayaking nearby
- Mountain biking nearby
- Rafting nearby
- Sailing nearby
- Segway rental/tour nearby
Awards and affiliations
Green / Sustainable Property
This property participates in Green Key Eco-Rating Program, a program that measures the property's impact on one or more of the following: environment, community, cultural-heritage, the local economy.
- This property is affiliated with the International Gay & Lesbian Travel Association (IGLTA) and welcomes lesbian, gay, bisexual, and transgender (LGBT) guests.
Park Hyatt Washington's small print
Also known as
- Park Hyatt Washington Hotel Washington D.C.
- Park Hyatt Washington
- Hyatt Washington Dc
- Park Hyatt Hotel Washington DC
- Park Hyatt Washington DC
- Hotel Park Hyatt Washington Washington Dc
- Hyatt Hotel Washington Dc
- Park Hyatt Washington Hotel
- Hotel Park Hyatt Washington
- Park Hyatt Washington Washington
The property has connecting/adjoining rooms, which are subject to availability and can be requested by contacting the property using the number on the booking confirmation.
Children under 16 years old are not allowed in the swimming pool without adult supervision.
Reservations are required for massage services and spa treatments and can be made by contacting the property before arrival at the number on the booking confirmation.
Mandatory fees
Pet deposit: USD 100 per stay
Optional extras
Valet parking costs USD 49 per night with in/out privileges
Rollaway beds are available for USD 50 per night
Pets are allowed for an extra charge of USD 100 per accommodation, per stay
We have included all charges provided to us by this hotel. However, charges can vary, for example, based on length of stay or the room you book.


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Chris Evans
Chris Pratt Lost A Super Bowl Bet To Chris Evans, But The Results Prove They're True Heroes
Chris Pratt and Chris Evans are proving that they are true super heroes, both on and off the silver screen!
Forbes Reveals The Top 10 Highest-Grossing Actors Of 2014
Forbes is taking a look back at the Top 10 Highest Grossing Actors of 2014, and a fan favorite has grabbed the No. 1 spot!
Update: Andrew Garfield Upset Oscars Segment Was Dropped, Meets 'Batkid' At Disneyland
'Andrew did the right thing for Batkid and anyone saying otherwise is flat out lying,' a rep for the actor said in a recent statement.
Marvel's Thor Premiere Cast Interviews
Thor Movie Premiere Photosview gallery The Summer movie season officially kicks off this Friday with THOR, the latest super hero blockbuster based on the Marvel Comics hero! Thor was awesome (check out our review here!), and […]


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Talk:Close Encounters of the Third Kind
|This is the talk page for discussing improvements to the Close Encounters of the Third Kind article.
Article policies
|Archives: 1
|This article is of interest to the following WikiProjects:
|Close Encounters of the Third Kind has been listed as one of the Media and drama good articles under the good article criteria. If you can improve it further, please do so. If it no longer meets these criteria, you can reassess it.
Writing Credits - Julia Phillips book[edit]
Some mention should be made of Julia Phillips' claim in "You'll Never Eat Lunch in this Town Again" that Spielberg had her strong arm the other writers not to seek WGA-mandated credits on the film because he wanted sole credit. And to this day, he has never had a single credit on one of his films again. — Preceding unsigned comment added by 18.104.22.168 (talk) 01:54, 12 February 2015 (UTC)
References to use[edit]
- Please add to the list references that can be used for the film article.
- Booker, M. Keith (2006). "Close Encounters of the Third Kind". Alternate Americas: Science Fiction Film and American Culture. Praeger. pp. 125–140. ISBN 0275983951.
- Telotte, J. P. (2001). "The Science Fiction Film as Marvelous Text: Close Encounters of the Third Kind". Science Fiction Film. Genres in American Cinema. Cambridge University Press. pp. 142–160. ISBN 0521596475.
Music Section[edit]
I fixed the music section some. It seems to have been written by a person who does not know English very well. I certainly appreciate their good attempt! I also added some detail of a very slight musical technical nature to that section. I think it can be expanded on enormously!Gingermint (talk) 22:46, 29 October 2010 (UTC)
- I haven't checked its writing style yet, but I do want to suggest that we move the section on the soundtrack to its own article, as its highly notable and is not the film. the material on the famous 5 notes could go in either or both articles, as its directly relevant to the film. I see this a lot, where a film article includes the album, book source, play source, etc, when those entities often are notable in their own right.Mercurywoodrose (talk) 17:19, 9 October 2011 (UTC)
- The section has been rewritten in 2011 (since Gingermint wrote his/her message above) and so the "writing style" is no longer an issue. With regards to giving the music section its own article, I'm not sure that it warrants it because the section covers it fairly well without being too long. If people feel that it appears too long, then I would suggest using the hide/show functions for the track listings of the different album releases to make the section more compact. I think a soundtrack album for a film is different than a stage play or novel that later became a film because they are truly separate works (though a mere novelisation of a film would not warrant a separate article). I can understand a separate article for the Saturday Night Fever soundtrack album (due to its cultural significance alone) but the Close Encounters soundtrack isn't quite as notable or prominent. 126.96.36.199 (talk) 09:22, 13 November 2011 (UTC)
CE3K and UFO's in Society[edit]
I'm reading a great book that includes essays from 1977 to 1997, it was a column written for Skeptical Inquirer magazine called "Psychic Vibrations" by Robert Sheaffer. I'm fascinated at how much the influence the movie CE3K had on the UFO community and think it would be an interesting entry on this page. Wondering if anyone would care if I worked something up when I completely finish the book? Sgerbic (talk) 05:02, 17 October 2011 (UTC)
Some internet searches seem to corroborate my belief that the musical/mathematical language used in the movie is actually Solresol -- Can anyone support this with relevant sources ? Summsumm2 (talk) 09:21, 20 December 2012 (UTC)
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my 86 crown vic want stay running i changed fuel pump but for some reason when the pump is hooked up it want start but if i unplug the pump it a fire up an run for a lil bit i need help.
2 Answers
have you looked at your fuel pressure regulator at all, it is a diaphragm with a vacuum connection to it, on or just before the fuel rail...perhaps this is disconnected and givin' too much pressure....those butyl rubber vacuum hoses are cracky and leaky too~ replace with silicone vacuum lines~
Did you replace the fuel filter and FP relay also? Check the low oil pressure switch and check the inertia switch both of them can really give you a headache.
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For those of the TL;DR variety: I screwed it up for everyone.
The town played this game absolutely disastrously. Most of them didn't much think about what they were doing, and didn't even pay attention. They just let the mafia blatantly herd them from lynch to lynch. It would have gone better if the town had worked together and played smarter:First off, the forensic analysts both claimed simultaneously when they had uselessly low amounts of letters. They should have waited and gotten more letters before claiming, and they would not have been slaughtered. The only reason Protus didn't die immediately after Kristopher is because ekster was furiously protecting him. As you can see he was targeted twice in a row. Secondly because they didn't wait for more letters, they got confused about their role. Random means random which means the possibility of getting the same letter, multiple times. Had they waited and not jumped the gun, that would have become clear, and so would the fact that the a and the t were different people, not the same person. This key mistake led directly to both the lynch of the last investigator and of Antony. ekster, Krisnatharok and Brom all played it smart: they never claimed or breadloafed at what they were. Antonica and tmod were also playing well, and would have been quite useful had AVD not shot Antonica. Brom was only shot becuase the mafia needed an easy unprotected target to win, and he was the least active. ekster stuck with his protection, which is pretty much the only reason this game ended in day 3 rather than day 2. At the same time as all this, the town was letting themselves just get herded by the mafia to lynches, and not even caring or realizing it, even though it was fairly obvious.All in all, the town played bad, allowing the mafia to cruise effortlessly to victory. Remember, this is a THINKING GAME.It was pretty fun to watch though.
And I don't completely buy Modem's "random", but have to give him the benefit of the doubt.
2b. Kris needs to stop pushing so much that it forces people to claim. Pushing to get reactions is one thing, pushing to get claims is another.
That was my argument in the game too.
Thanks for hosting. Great game!
#1 - MOD Fail 1a. Unbalanced game with 4 mafia. A game should never be able to be LoL after Day 1.
25% is the normal average.. but it varies depending on roles. 2 would have been too little.
linked characters are dumb... if their roles are linked thats one thing, but the "if one dies you both die" bullshit sucks. Unless you are mafia, then it's a free win.


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Posts tagged "obesity"
Fatphobia: A Guide For The Disbeliever
This piece was crossposted with permission from KittyStryker.com. First, a little bit about me. I'm an American who has lived on one coast or the other, who has spent extended time in Poland and in London. I've been familiar with fatphobia my whole life, as my mother is fat, my grandmother is fat, and…
Kitty Stryker
May 6, 2014
My Love Of Coca-Cola And Its Decline In North America
I think it might be time for me to partake in a Coca-Cola addiction intervention, because apparently, many fellow North American addicts have kicked the habit. Now I'm just feeling left out and in fear of the shakes. Unfortunately (for me, but probably beneficial for the obesity issue in America), Coca-Cola's profit ha…
Daley Quinn
July 17, 2013
Obesity Is Now Recognized As A "Disease" By The American Medical Association
Lesley Kinzel from xoJane on how the American Medical Association classified obesity as a "disease" yesterday, but that really doesn't mean a whole lot in a society with such a warped image of women's bodies. [xoJane] A Christian college in Pennsylvania can exclude the morning-after pill and birth control from the college…
Jessica Wakeman
June 19, 2013
Fat Fetish Model Consumes 5,000 Calories A Day To Achieve Her Dream
Everyone has a dream. Snoop Lion wanted to be a pimp when he grew up. And 23-year-old Tammy Jung wants to hit 420 lbs. so she can be a high-roller fat fetish model. Jung has been eating 5,000 calories a day in the hopes she'll pack on the roughly 40 extra pounds she…
Jessica Wakeman
May 10, 2013
Kirstie Alley Continues Her Fat-Shaming Reign Of Terror
Kirstie Alley has good Photoshop skills, but questionable judgment when it comes to pointing out her weight issues. She posted this pic of her head Photoshopped onto a fat woman's body on Twitter, cracking jokes about drinking beer and whether her "butt looks big." I can appreciate that she's a celeb willing to poke fu…
Jessica Wakeman
March 26, 2013
Brazil's Created Special Seating For Obese Olympics Fans
Excited to head to Brazil's 2014 Olympic Summer Games? Well, if you're obese, expect to pay a little bit more to enjoy the sports. Where standard-sized stadium seats start at $28, all obese seating is $58. Brazilian law defines obesity as a "disability," and as such requires that the stadium be properly outfitted…
Julie Gerstein
March 1, 2013
Watch A Sneak Peek Of TLC's Crime Documentary, "Half-Ton Killer?"
We need to talk about the upcoming TLC documentary, "Half-Ton Killer." If you've seen TLC's other "Half-Ton" docs ("Half-Ton Mom," "Half-Ton Teen," etc.), this is a different beast. Yes, Mayra Rosales does weigh a half-ton. Actually she weighs 1,100 pounds and is considered one of the heaviest women in the world. But this is not…
Ami Angelowicz
September 23, 2012
World's Heaviest Woman Is Shedding The Pounds With The Sex Diet
Pauline Potter took the title of the Guinness Book World Record's Fattest Woman at 728 pounds. She packed on the pounds after divorcing her husband Alex, binging on about 10,000 calories a day. I'll provide some calorie math for you. Ten thousand calories a day works out to be four bowls of cereal, a box…
Ami Angelowicz
July 11, 2012
Obese People Should Get Counseling, Panel Advises
Earlier this week, a federal health advisory panel recommended that obese adults receive intensive counseling in order to address the mounting obesity epidemic in America. The U.S. Preventive Services Task Force encouraged doctors to identify and aid obese patients by providing counseling, or referring them to a weight loss-oriented program. Specially targeted: patients with a…
Julie Gerstein
June 26, 2012
865-Pound Teen Cut Out Of House In UK
Emergency workers who needed to take an obese teenager from her home to a hospital in Wales had to break through a wall of the residence to get her out and into an ambulance, officials said Friday. The rescue on the second floor of the small house on Thursday used scaffolding as a ramp to…
The Huffington Post
May 26, 2012
C-Section Births Tied To Obesity
Caesarian sections are on the rise in the United States, but a new study out yesterday indicates that the surgical birth method may have an unexpected consequence. It found that babies born by C-section are twice as likely to be obese by age three, reports the Washington Post. Researchers reviewing the records of 1,255 mothers and…
May 24, 2012
Jamie Oliver Proves That Heaven Exists
Okay, okay, celebrity chef Jamie Oliver was actually using this glorious table of junk food to prove a point about the dangers of obesity as he kicked off a healthy cooking and nutrition initiative in Melbourne, Australia. I really admire Jamie and his work, but if I'm being completely honest, looking at this picture gave…
Winona Dimeo-Ediger
March 6, 2012
Facts About America's Warped Body Ideals Are "Controversial" Somehow
Naked models usually gets mouths flapping. But the real reason people are gabbing about a photo spread in Plus Model Magazine is because each picture of plus-size model Katya Zharkova posing nude is accompanied by a fact about body size and eating disorders. In the image from the spread shown above left, Katya even hold…
Jessica Wakeman
January 11, 2012
Munchies, Shmunchies: Pot Smokers Are Less Likely To Be Obese
It must be all those pot brownies and long nights spent playing video games. According to a new study, pot smokers are less likely to be obese than their non-toking peers. No, like seriously. A researcher at Louis Mourier Hospital in France was so surprised by her initial finding that she went back to the…
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"Maggie Goes On A Diet," Children's Diet Book, Criticized For Hurting Body Image
Add this to your fall reading list (or book burning pile): Maggie Goes On A Diet, a children's book for elementary schoolers, about an obese 14-year-old girl named Maggie who loses weight and becomes the school soccer star. As you can imagine, quite a few people are not happy with this. Bitch Magazine…
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August 22, 2011
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"Guys Who Like Fat Chicks." I assumed the worst when I read that headline. Can you blame me? As I started to read the Village Voice article about men who are attracted to obese women, I prepared myself to be offended by men who objectify and fetishize a stigmatized, marginalized group of…
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May 6, 2011
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For Fat, Head to Mississippi
Aside from being one of the hardest states to spell, Mississippi is also the fattest state. At least according to the folks over at CalorieLab, who calculated the rankings based on the Behavioral Risk Factor Surveillance System database maintained by the Centers for Disease Control and Prevention. Around 33.8 percent of Mississippi's adult population i…
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November 12, 2010
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September 9, 2010
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Teresa Giudice & Family Sit For Prison Portrait
Making memories!
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lsr75 Posted:
Bikeral Posted:
Accel solenoid was included in an "Electric Start" kit I purchased. Bad right out of the box. Bought another Accel solenoid and it failed in a month. I will never buy another Accel product.
TimTabor Posted:
Quality part, arrived on schedule.
brancacciom Posted:
Not bad just not for shovelheads
firstname.lastname@example.com Posted:
Works well
EL Rancho LOCO Posted:
worked perfect. had a question and tech helped right a way.
tkpowwow Posted:
thanks, just what I needed
OLD TOM Posted:
sosgeneral Posted:
works great
firstname.lastname@example.com Posted:
Works like a charm
golden22440 Posted:
This fixed my starting problem.
clark2469 Posted:
I got exactly what I ordered and in a timely fashion. J&P Cycles is the best!!
Chris Bjarnson Posted:
Works just fine. 0 problems.
mikeglynn Posted:
I'm sure its fine. The last one didn't work to well but I had other problems.
driskell Posted:
Works awesome
jhanika Posted:
Perfect Fit. Worked as it should. Bike fired up on first try. And it looks good to.
tmtrnka Posted:
Fits and works great.
Maxxra Posted:
Always nice to see the non-chrome version selling for less. Thank you!
shovelskull Posted:
Solenoid is great
woobdawg Posted:
like it is a brand new starter
83fxwg Posted:
good quality and works great
hdsawyer Posted:
kpneedham Posted:
got just about 20 starts out of this "heavy duty" solenoid before it froze up and smoked my starter motor. Junk part
62duoglide Posted:
Good product at a decent price.
tedali2004 Posted:
Works like it should. Don't forget to order the gasket (3800370).
65_glide Posted:
Working well on the bike, but the mount had a slight bend in it, and wasn't consistent. But, it's doing it's job.
wa7zcz Posted:
Solid and dependable.
shawnL89 Posted:
Loved the product, easy to install, and works great! Plus looks great with the rest of my bike.
andrew-pierson Posted:
JP Cycles was very helpful.
rlalor Posted:
Works as well the OEM part. For the price, good bargain!
RobSchoenwald Posted:
Had trouble with the first one sticking. sent back to J&P and they replaced it no questions asked... now works great!
andrew-pierson Posted:
Solenoid worked great, I hadn't ridden the bike in awhile and when I tried to start it up the solenoid clicked. I pulled the cover off and some how the plastic was all busted. Product worked great, but apparently the plastic isnt very strong.
Ratster123 Posted:
Works good on 76'FL. High quality.
snleclaire1111 Posted:
worked perfectly.
mann Posted:
tjaynes Posted:
Fits perfect! Works better than the cheepos!!
dj611229 Posted:
Works like a charm
guitartucson Posted:
Service was excellent
dadb123 Posted:
was an exact copy of original. very good fit and quality
lex718 Posted:
What can I say, it does what it's supposed to do. Many thanks. Great service.
machishag Posted:
Works well. Same installation as OEM unit.
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Covering deer loving plants?
gardenspuds(CA- SF Bay area)March 5, 2008
We recently moved into a house that has deer occasionally coming into the yard.
I planted some roses in containers for our deck.
Has anyone ever tried covering plants to prevent the deer from eating the plants?
I was thinking of covering the plants in the pots either with shade cloth at night, or if anyone can think of a more "permanent" solution, what would it be?
You'll definitely have to cover them in some way, but at night might not be enough, as deer generally feed at dawn and dusk. I'd try bird netting, just wrap it around the plants as a deterrent. I have some neighbors that do that with their roses, and I haven't asked the deer how it's working, but there are occasional blooms on them, so it must be doing something!


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