Tricuspid regurgitation echocardiography

Jump to navigation Jump to search

Tricuspid Regurgitation Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Tricuspid Regurgitation from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

Stages

History and Symptoms

Physical Examination

Laboratory Findings

Echocardiography

Cardiac CT

Cardiac MRI

Chest X Ray

Electrocardiogram

Cardiac Stress Test

Cardiac Catheterization

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical therapy

Surgery

Primary Prevention

Secondary Prevention

Case Studies

Case #1

Tricuspid regurgitation echocardiography On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Tricuspid regurgitation echocardiography

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA onTricuspid regurgitation echocardiography

CDC on Tricuspid regurgitation echocardiography

Tricuspid regurgitation echocardiography in the news

Blogs on Tricuspid regurgitation echocardiography

Directions to Hospitals Treating Tricuspid regurgitation

Risk calculators and risk factors for Tricuspid regurgitation echocardiography

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Vamsikrishna Gunnam M.B.B.S [2] Rim Halaby, M.D. [3] Fatimo Biobaku M.B.B.S [4] Basir Gill, M.B.B.S, M.D.[5]

Overview

Transthoracic echocardiography (TTE) is usually adequate for the evaluation of tricuspid regurgitation; to confirm the diagnosis, determine the etiology, establish the baseline severity and for the assessment of the function of the right ventricle prior to surgery. In cases of non-diagnostic transthoracic studies, transesophageal echocardiography (TEE) improves the visualization of the valvular structure and delineates the mechanism and severity of regurgitation.

Echocardiography

Echocardiography with doppler is the method of choice for the non-invasive detection and evaluation of the severity and etiology of valvular regurgitation. [1][2]Echocardiography allows the evaluation of the following:[3][4][5][6][7][8]

Comprehensive assessment of the anatomy of functional tricuspid regurgitation by transthoracic three-dimensional echocardiography. Two-dimensional color Doppler showing severe functional tricuspid regurgitation (A). En faces view of the tricuspid valve leaflets and annulus from the right atrial perspective (B). En faces view of the tricuspid valve leaflets from the right ventricular perspective (C). Semi-automated quantitative analysis of tricuspid annulus size and shape, showing the relationship with the 4-chamber view plane (green line along the septal-lateral direction; D). Lateral view showing the flattening of tricuspid annulus (E). Surface rendering and quantitative analysis of tricuspid annulus and leaflets (F). A: anterior tricuspid leaflet, Ao: aorta, IVC: inferior vena cava, MV: a mitral valve, P: posterior tricuspid leaflet, RVOT: right ventricular outflow tract, S: septal tricuspid leaflet. Case courtesy by Denisa Muraru[11]


https://commons.wikimedia.org/wiki/File:Severe_tricuspid_regurgitation_E00572_(CardioNetworks_ECHOpedia).jpg#/media/File:Severe_tricuspid_regurgitation_E00572_(CardioNetworks_ECHOpedia).jpg


Grading severity of TR

While Transthoracic Echocardiography (TTE) remains the first-line modality, its results are dependent on acoustic windows and operator expertise, which can lead to the underestimation of TR severity.[12] To address consistent underestimation, the 2025 European guidelines have adopted specific cutoffs for 3D vena contracta area (≥75 mm2) and proximal isovelocity surface area (≥75 mm2).[12][13] Comprehensive assessment must include 3D color Doppler to measure the vena contracta area without geometric assumptions, though high-resolution image acquisition remains a challenge.[14] Severity grading has been expanded to a 5-grade scale—including 'massive' and 'torrential' beyond the 'severe' category—which has shown significant prognostic importance for both medical and transcatheter therapies.[15] Transesophageal echocardiography (TEE), specifically 3D TEE, is essential for enhanced valve visualization and provides critical guidance during transcatheter tricuspid valve interventions (TTVI).[16] Assessment of TR severity should ideally be performed when the patient is in a euvolemic state, as the severity can fluctuate significantly based on cardiac loading conditions.[17] Intraprocedural monitoring often utilizes 3D intracardiac echocardiography to supplement TEE, particularly to confirm successful leaflet grasping during edge-to-edge repair procedures.[18][19]

Threshold values for the echocardiographic parameters used to grade TR severity[20][21]
Mild (1+) Moderate (2+) Severe (3+) Massive (4+) Torrential (5+)
Qualitative
Tricuspid

Morphology

Normal or mildly abnormal Moderately abnormal Severely abnormal (flail leaflet, large coaptation gap, marked tethering)
Color-flow jet area Small, narrow, central Moderate central Large central, or eccentric, wall impinging
Flow convergence zone Not visible, transient, or small Intermediate in size and duration Large throughout systole
CW-Doppler contour Faint,                  partial,

parabolic

Dense, parabolic Dense, parabolic                 or

triangular

Dense, often

triangular,

may have low peak velocity

Dense, usually triangular, often low peak velocity
Right heart size Usually normal Normal or mild

dilation

Usually dilated Dilated
Semiquantitative
VC width, mm <3 3-6.9 7-13.9 14-20.9 ≥21
PISA radius, mm ≤5.4 5.5-8.9 ≥9
Hepatic vein flow Systolic dominant Systolic blunting Systolic flow reversal
Tricuspid inflow A-wave dominant Variable E-wave dominant (≥1 m/s)
Quantitative
PISA EROA, mm2 <20 20-39 40-59 60-79 ≥80
Doppler volumetric 75-94.9 95-114.9 ≥115
EROA, mm2
PISA RegVol, (mL) <30 30-44 45-59 60-74 ≥75
RegFrac,  % <15 16-49% ≥50
3D Vena contracta area, mm2 75-94.9 95-114.9 ≥115


2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines[22]

Recommendations for Diagnosis of TR

Class I
1.   In patients with TR, TTE is indicated to evaluate the presence and severity of TR, determine the etiology, measure the sizes of the right-sided chambers and inferior vena cava, assess RV systolic function, estimate pulmonary artery systolic pressure, and characterize any associated left-sided heart disease. (Level of Evidence: C-LD)"


2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary[3]

Class I
"1. TTE is indicated to evaluate severity of TR, determine etiology, measure sizes of right-sided chambers and inferior vena cava, assess RV systolic function, estimate pulmonary artery systolic pressure, and characterize any associated left-sided heart disease. (Level of Evidence: C)"
Class IIb
"1. CMR or real-time 3-dimensional echocardiography may be considered for assessment of RV systolic function and systolic and diastolic volumes in patients with severe TR (stages C and D) and suboptimal 2-dimensional echocardiograms. (Level of Evidence: C)"

==2008 ACC/AHA Guidelines for the Management of Patients with Valvular Heart Disease - Evaluation of Tricuspid Valve Disease in Adolescents and Young Adults(DO NOT EDIT)[23]


Class I
"1. Doppler echocardiography is indicated for the initial evaluation of adolescent and young adult patients with TR, and serially every 1 to 3 years, depending on severity. (Level C)"

Sources

  • 2008 ACC/AHA Guidelines incorporated into the 2006 guidelines for the management of patients with valvular heart disease. [23]

References

  1. ↑ Tornos Mas P, Rodríguez-Palomares JF, Antunes MJ (2015). "Secondary tricuspid valve regurgitation: a forgotten entity". Heart. 101 (22): 1840–8. doi:10.1136/heartjnl-2014-307252. PMC 4680164. PMID 26503944.
  2. ↑ Zoghbi WA, Enriquez-Sarano M, Foster E, Grayburn PA, Kraft CD, Levine RA; et al. (2003). "Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography". J Am Soc Echocardiogr. 16 (7): 777–802. doi:10.1016/S0894-7317(03)00335-3. PMID 12835667 PMID: 12835667 Check |pmid= value (help).
  3. ↑ 3.0 3.1 Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA; et al. (2014). "2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines". Circulation. 129 (23): 2440–92. doi:10.1161/CIR.0000000000000029. PMID 24589852.
  4. ↑ Chen TE, Kwon SH, Enriquez-Sarano M, Wong BF, Mankad SV (2013). "Three-dimensional color Doppler echocardiographic quantification of tricuspid regurgitation orifice area: comparison with conventional two-dimensional measures". J Am Soc Echocardiogr. 26 (10): 1143–1152. doi:10.1016/j.echo.2013.07.020. PMID 23993694.
  5. ↑ de Agustin JA, Viliani D, Vieira C, Islas F, Marcos-Alberca P, Gomez de Diego JJ; et al. (2013). "Proximal isovelocity surface area by single-beat three-dimensional color Doppler echocardiography applied for tricuspid regurgitation quantification". J Am Soc Echocardiogr. 26 (9): 1063–72. doi:10.1016/j.echo.2013.06.006. PMID 23860094.
  6. ↑ Zoghbi, William A.; Adams, David; Bonow, Robert O.; Enriquez-Sarano, Maurice; Foster, Elyse; Grayburn, Paul A.; Hahn, Rebecca T.; Han, Yuchi; Hung, Judy; Lang, Roberto M.; Little, Stephen H.; Shah, Dipan J.; Shernan, Stanton; Thavendiranathan, Paaladinesh; Thomas, James D.; Weissman, Neil J. (2017). "Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation". Journal of the American Society of Echocardiography. 30 (4): 303–371. doi:10.1016/j.echo.2017.01.007. ISSN 0894-7317.
  7. ↑ Hahn, Rebecca T.; Thomas, James D.; Khalique, Omar K.; Cavalcante, João L.; Praz, Fabien; Zoghbi, William A. (2019). "Imaging Assessment of Tricuspid Regurgitation Severity". JACC: Cardiovascular Imaging. 12 (3): 469–490. doi:10.1016/j.jcmg.2018.07.033. ISSN 1936-878X.
  8. ↑ Hudzik B, Poloński L, Gąsior M (2016). "Lancisi sign: giant C-V waves of tricuspid regurgitation". Intern Emerg Med. 11 (8): 1139–1140. doi:10.1007/s11739-015-1384-4. PMC 5114320. PMID 26758273.
  9. ↑ Adler, Dale S. (2017). "Non-functional tricuspid valve disease". Annals of Cardiothoracic Surgery. 6 (3): 204–213. doi:10.21037/acs.2017.04.04. ISSN 2225-319X.
  10. ↑ Paranon, S.; Acar, P. (2008). "Ebstein's anomaly of the tricuspid valve: from fetus to adult". Heart. 94 (2): 237–243. doi:10.1136/hrt.2006.105262. ISSN 1355-6037.
  11. ↑ "Revisit of Functional Tricuspid Regurgitation; Current Trends in the Diagnosis and Management".
  12. ↑ 12.0 12.1 Praz, F., Borger, M. A., Lanz, J., Marin-Cuartas, M., Abreu, A., Adamo, M., Ajmone Marsan, N., Barili, F., Bonaros, N., Cosyns, B., De Paulis, R., Gamra, H., Jahangiri, M., Jeppsson, A., Klautz, R. J. M., Mores, B., Pérez-David, E., Pöss, J., Prendergast, B. D., … Moorjani, N. (2025). 2025 ESC/EACTS Guidelines for the management of valvular heart disease: Developed by the task force for the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). European Heart Journal, 46(44), 4635–4736. https://doi.org/10.1093/eurheartj/ehaf194
  13. ↑ Tomaselli, M., Penso, M., Badano, L. P., Clement, A., Radu, N., Heilbron, F., Gavazzoni, M., Hădăreanu, D. R., Oliverio, G., Fisicaro, S., Springhetti, P., Pece, C., Delcea, C., & Muraru, D. (2025). Association with outcomes of correcting the proximal isovelocity surface area method to quantitate secondary tricuspid regurgitation. Journal of the American Society of Echocardiography: Official Publication of the American Society of Echocardiography, 38(3), 195–207. https://doi.org/10.1016/j.echo.2024.10.015
  14. ↑ Lancellotti, P., Pibarot, P., Chambers, J., La Canna, G., Pepi, M., Dulgheru, R., Dweck, M., Delgado, V., Garbi, M., Vannan, M. A., Montaigne, D., Badano, L., Maurovich-Horvat, P., Pontone, G., Vahanian, A., Donal, E., Cosyns, B., & the Scientific Document Committee of the European Association of Cardiovascular Imaging. (2022). Multi-modality imaging assessment of native valvular regurgitation: an EACVI and ESC council of valvular heart disease position paper. European Heart Journal - Cardiovascular Imaging, 23(5), e171–e232. https://doi.org/10.1093/ehjci/jeab253
  15. ↑ Hahn, R. T., & Zamorano, J. L. (2017). The need for a new tricuspid regurgitation grading scheme. European Heart Journal Cardiovascular Imaging, 18(12), 1342–1343. https://doi.org/10.1093/ehjci/jex139
  16. ↑ Hahn, R. T., Saric, M., Faletra, F. F., Garg, R., Gillam, L. D., Horton, K., Khalique, O. K., Little, S. H., Mackensen, G. B., Oh, J., Quader, N., Safi, L., Scalia, G. M., & Lang, R. M. (2022). Recommended standards for the performance of transesophageal echocardiographic screening for structural heart intervention: From the American society of echocardiography. Journal of the American Society of Echocardiography: Official Publication of the American Society of Echocardiography, 35(1), 1–76. https://doi.org/10.1016/j.echo.2021.07.006
  17. ↑ Hahn, R. T., & Zamorano, J. L. (2017). The need for a new tricuspid regurgitation grading scheme. European Heart Journal Cardiovascular Imaging, 18(12), 1342–1343. https://doi.org/10.1093/ehjci/jex139
  18. ↑ Gilbert H.L. Tang, MD, MSc, MBA, Zaid, S., Hahn, R. T., Aggarwal, V., Alkhouli, M., Aman, E., Berti, S., Chandrashekhar MD DM, Y., Chadderdon, S. M., D’Agostino, A., Fam, N. P., Ho, E. C., Kliger, C., Kodali, S. K., Krishnamoorthy, P., Latib, A., Lerakis, S., Scott Lim, D., Mahadevan, V. S., … von Bardeleben, R. S. (2025). Structural Heart Imaging Using 3-Dimensional Intracardiac Echocardiography: JACC: Cardiovascular Imaging Position Statement. Cardiovascular Imaging. https://doi.org/10.1016/j.jcmg.2024.05.012
  19. ↑ Wang, L., Tokhi, B., Petrossian, G. A., Chung, W. B., Khalique, O., Cohen, D. J., & Khan, J. M. (2025). Streamlined imaging and procedural workflow for tricuspid transcatheter edge-to-edge repair. JACC. Cardiovascular Imaging, 18(4), 500–510. https://doi.org/10.1016/j.jcmg.2025.01.010
  20. ↑ Invalid <ref> tag; no text was provided for refs named :0
  21. ↑ Hahn, R. T., & Zamorano, J. L. (2017). The need for a new tricuspid regurgitation grading scheme. European Heart Journal Cardiovascular Imaging, 18(12), 1342–1343. https://doi.org/10.1093/ehjci/jex139
  22. ↑ Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F; et al. (2021). "2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". Circulation. 143 (5): e72–e227. doi:10.1161/CIR.0000000000000923. PMID 33332150 Check |pmid= value (help).
  23. ↑ 23.0 23.1 Bonow RO, Carabello BA, Chatterjee K; et al. (2008). "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 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". Circulation. 118 (15): e523–661. doi:10.1161/CIRCULATIONAHA.108.190748. PMID 18820172. Unknown parameter |month= ignored (help)

Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Tricuspid_regurgitation_echocardiography&oldid=1743343"