Qualitative
Tricuspid valve morphology
Colour flow TR jeta
CW signal of TR jet
Semi-quantitative
VC width (mm)a
PISA radius (mm)b
Hepatic vein flowc
Tricuspid inflow
Quantitative
EROA (mm2)
R Vol (mL)
RA/RV/IVC dimension
| Tricuspid valve morphology |
| Mild |
| Normal/abnormal |
| Moderate |
| Normal/abnormal |
| Severe |
| Abnormal/flail/large coaptation defect |
| Colour flow TR jeta |
| Mild |
| Small, central |
| Moderate |
| Intermediate |
| Severe |
| Very large central jet or eccentric wall impinging jet |
| CW signal of TR jet |
| Mild |
| Faint/Parabolic |
| Moderate |
| Dense/Parabolic |
| Severe |
| Dense/Triangular with early peaking (peak <2 m/s in massive TR) |
| VC width (mm)a |
| Mild |
| Not defined |
| Moderate |
| <7 |
| Severe |
| ≥7 |
| PISA radius (mm)b |
| Mild |
| ≤5 |
| Moderate |
| 6–9 |
| Severe |
| >9 |
| Hepatic vein flowc |
| Mild |
| Systolic dominance |
| Moderate |
| Systolic blunting |
| Severe |
| Systolic flow reversal |
| Tricuspid inflow |
| Mild |
| Normal |
| Moderate |
| Normal |
| Severe |
| E wave dominant (≥1 m/s)d |
| EROA (mm2) |
| Mild |
| Not defined |
| Moderate |
| Not defined |
| Severe |
| ≥40 |
| R Vol (mL) |
| Mild |
| Not defined |
| Moderate |
| Not defined |
| Severe |
| ≥45 |
| RA/RV/IVC dimension |
| Unless for other reasons, the RA and RV size and IVC are usually normal in patients with mild TR. An end-systolic RV eccentricity index .2 is in favour of severe TR. In acute severe TR, the RV size is often normal. In chronic severe TR, the RV is classically dilated. Accepted cut-off values for non significant right-sided chambers enlargement (measurements obtained from the apical four-chamber view): Mid RV dimension ≤33 mm, RV end-diastolic area ≤28 cm2, RV end-systolic area ≤16 cm2, RV fractional area change >32%, maximal RA volume ≤33 mL/m2. An IVC diameter ,1.5 cm is considered normal. |
CW = continuous-wave; EROA = effective regurgitant orifice area; RA = right atrium; RV = right ventricle; R Vol = regurgitant volume; TR = tricuspid regurgitation; VC = vena contracta.
aAt a Nyquist limit of 50–60 cm/s - bBaseline Nyquist limit shift of 28 cm/s - cUnless other reasons of systolic blunting (atrial fibrillation, elevated RA pressure) - dIn the absence of other causes of elevated RA pressure.