Tricuspid regurgitation can be broadly divided into hypertensive and non-hypertensive, depending on the right ventricular pressure, whether it is elevated or not. Tricuspid regurgitation is best assessed in the apical four chamber view on echocardiography. This is because the direction of the jet and the Doppler beam are parallel to each other in this view. Hence the estimation of the jet velocity will be more accurate in this view. The more distally the jet extends from the tricuspid valve into the right atrium, the more severe the regurgitation. A larger jet area on colour Doppler also indicates a severe regurgitation.
Colour Doppler in tricuspid regurgitationThis is a tricuspid regurgitation jet seen on colour Doppler echocardiography from the apical four chamber view. RV right ventricle; LV left ventricle; LA left atrium; RA right atrium. The mosaic colour indicates high velocity with aliasing while the proximal most portion of the jet in right atrium is blue indicating flow away from the transducer. The tricuspid regurgitation in this case was moderate to severe. The right atrium and right ventricle are dilated due to pulmonary hypertension. A prominent moderator band is seen in the right ventricle distally, appearing to divide the right ventricle into a proximal and distal chamber. Actually there is no division into two chambers as the moderator band is not large in three dimensions to divide the right ventricle into two cavities. This apparent division is only in a particular frame.
If isolated severe tricuspid regurgitation is noted without pulmonary hypertension a close look at the valve leaflets for any vegetations suggesting infective endocarditis is needed.
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