This document discusses how to evaluate tricuspid regurgitation (TR) using echocardiography. It provides two case examples: 1. A case of secondary TR due to annular dilatation from right atrial and ventricular dilatation. Severe TR is shown by a large regurgitant jet on color flow mapping with a measurable vena contracta and proximal flow convergence. 2. A case of primary organic TR involving prolapse or a flail leaflet. Severe TR is evident before color flow mapping due to right heart dilation and dysfunction. Color flow mapping shows a torrential regurgitant jet with a wide vena contracta and proximal flow convergence. The document reviews

1. Vinayak Vadgaonkar
How to Echo TR….
“Case based approach”

2. Tricuspid valve anatomy

3. TR grades and severity

4. Important considerations….
R is secondary or functional TR due to annular dilatation from RA/RV dilatation in the setting of RV dysfunc
mon cause in Prolapse due to myxomatous degeneration.
based primarily on techniques used for MR severity.But MV and TV have different anatomy.
e severity is by color flow mapping.
ar; hence assessments of VC/EROA/RV not always accurate.
sured in Apical 4C view in end-diastole and cut-off is 40mm or21mm/m2.
tates TR.
tenting area are predictors of TR.

5. Case 1
Etiology?
Mechanism?

6. Mode of coaptation
Annulus dilatation

7. Color flow mapping

8. Fragment the jet by shifting color baseline

9. 3 Classical components of TR jet
Without shifting baseline With shift for hemispheric PISA

10. Pulsed doppler information
Pulmonary artery flow
Truncated notched pattern
Dominant E wave

11. Characteristic systolic flow reversal in hepatic veins specific for severe TR

12. Continous wave doppler information
Timing of TR-Holosystolic flowSpectral density-dense parabolic with cut off at peak

13. Severe TR related information
•Secondary TR with dilated annulus.
•Color flow mapping shows large jet with visualized PFC and VC @60cm/s.
•Dominant E wave on TV inflow.
•Hepatic vein systolic flow reversal.
•Dense parabolic holosystolic flow with “cut off sign”.
•Dilated and plethoric IVC.

14. Case 2
PLAX - huge RV Prolapse??
Non-coaptation with prolapse Non-coaptation
Etiology?
Mechanism?

15. Flail
Dilated right heart Severe RV dysfunction
Dilated annulus
Features of severe TR even before CFM

16. Color flow mapping
Flow convergence with torrential TR
Large regurgitant orifice
Wide VC

17. Classical components of TR jet without scale adjustments
VC PFC

18. Severe TR related information
• Primary organic Tricuspid regurgitation.
• Flail anterior or septal leaflet.
• Color flow mapping shows torrential severe TR with VC and PFC at scale of 60cm/s.

19. Algorithm

20. Questions….