Tricuspid valve
Mild:Usually normal
Moderate:Normal or abnormal
Severe:Abnormal/Flail leaflet/Poor coaptation
RV/RA/IVC size
Mild:Normal(1)
Moderate:Normal or dilated
Severe:Usually dilated(2)
Jet area-central jets (cm2)(3)
Mild:<5
Moderate:5-10
Severe:>10
VC width (cm)(4)
Mild:Not defined
Moderate:Not defined, but <0.7
Severe:>0.7
PISA radius (cm)(5)
Mild:≤0.5
Moderate:0.6-0.9
Severe:>0.9
Jet density and contour–CW
Mild:Soft and parabolic
Moderate:Dense, variable contour
Severe:Dense, triangular with early peaking
Hepatic vein flow(6)
Mild:Systolic dominance
Moderate:Systolic blunting
Severe:Systolic reversal

CW, Continuous wave Doppler; IVC, inferior vena cava; RA, right atrium; RV, right ventricle; VC, vena contracta width.

Similar to the assessment of other regurgitant lesions, an integrative approach is recommended for evaluation of TR. This includes evaluation of the size of right-sided chambers, septal motion and various Doppler parameters. Color Doppler flow mapping in at least 2 orthogonal planes should be performed, with particular attention to the vena contracta, flow convergence and the direction and size of the jet. CW Doppler recording of the TR jet should be recorded to evaluate the signal intensity and contour of the jet, and estimate pulmonary artery systolic pressure. Moreover, the size of the inferior vena cava and response to respiration as well as hepatic vein flow pattern help evaluate right atrial pressure and adaptation to the volume overload. With the lack of extensive data on quantitation of TR, the Task Force recommends integration of information from all available parameters discussed (Table 1). The more congruent the findings are regarding severity, the more confident the diagnosis. Inherent to this process is the particular attention to the quality of the data obtained, and to the physiologic conditions that can alter the accuracy of these parameters as indices of regurgitation severity.

  1. Unless there are other reasons for RA or RV dilation. Normal 2D measurements from the apical 4-chamber view: RV medio-lateral end-diastolic dimension ≤4.3 cm, RV end-diastolic area ≤35.5 cm2, maximal RA medio-lateral and supero-inferior dimensions ≤4.6 cm and 4.9 cm respectively, maximal RA volume ≤33 mL/m2 (35;89).
  2. Exception: acute TR.
  3. At a Nyquist limit of 50-60 cm/s. Not valid in eccentric jets. Jet area is not recommended as the sole parameter of TR severity due to its dependence on hemodynamic and technical factors.
  4. At a Nyquist limit of 50-60 cm/s.
  5. Baseline shift with Nyquist limit of 28 cm/s.
  6. Other conditions may cause systolic blunting (eg. atrial fibrillation, elevated RA pressure).