Echocardiography (Tricuspid valve)

Tricuspid valve PISA and alising velocity

Vmax TR (Peak tricuspidal regurgitation velocity)

EROA = 2π x PISAr² x Va / Vmax TR

Effective regurgitant orifice area

Is the narrowest area of tricuspid regurgitation flow.
It´s used to calculate: RegVol_TR

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

Echocardiography: tricuspid regurgitation severity echo

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Chronic tricuspid regurgitation
	Mild	Moderate	Severe
Structural
Tricuspid valve morphology	Normal or mildly abnormal leaflets	Moderately abnormal leaflets	Severe valve lesions (e.g., flail leaflet, severe retraction, large perforation)
Right atrium (Size)	Usually normal (RA major <45mm)	Normal or mild dilatation	Usually dilated¹ (RA major >45mm)
Right ventricle (Size)	Usually normal (RVD1_basal <41mm)	Normal or mild dilatation	Usually dilated¹ (RVD1_basal >41mm)
IVC_diameter Inferior vena cava diameter	Normal (IVC_diameter <2cm)	Normal or mildly dilated (IVC_diameter 2,1 - 2,5cm)	Dilated (IVC_diameter >2,5cm)
Qualitative doppler
RegJet_area Regurgitation jet area. (Nyquist limit 50-70cm/s)	Small, narrow, central (RegJet/RA area <20%)	Moderate central	Large central jet (RegJet/RA area >50%) or eccentric wall-impinging jet of variable size
Flow convergence (PISAr) (Nyquist limit 30-40cm/s)	Not visible, transient or small (PISAr <0,3cm)	Intermediate in size and duration	Large throughout systole (PISAr ≥1cm)
Regurgitant jet (CW doppler)	Faint/ partial/ parabolic	Dense but partial or parabolic	Dense, often triangular
Semiquantitative
RegJet_area (cm²) Regurgitation jet area (Nyquist limit 50-70cm/s)	Not defined	Not defined	>10
VCW (cm) Vena contracta width (Nyquist limit 50-70cm/s)	<0,3	0,3 - 0,69	≥0,7
PISAr (cm) (Nyquist limit 30-40cm/s)	≤0,5	0,6 - 0,9	>0,9
Hepatic vein flow²	Systolic dominance	Systolic blunting	Systolic flow reversal
Tricuspid inflow²	A wave dominant (A wave > E wave)	Variable	E wave (E wave >1m/s)
Quantitative
EROA (cm²) Effective regurgitant orifice area	<0,2	0,2 - 0,39³	≥0,4
RegVol (ml) Regurgitant volume of tricuspid regurgitation	<30	30 - 44³	≥45

Bolded signs are considered specific for their tricuspid regurgitation grade.

RV and RA size can be within the ‘‘normal’’ range in patients with acute severe TR.
Signs are nonspecific and are influenced by many other factors (RV diastolic function, atrial fibrillation, RA pressure).
There are little data to support further separation of these values.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Tricuspid valve PISA (Proximal isovelocity surface area radius)

PISAr

Proximal isovelocity surface area radius

The radius of PISA is measured from the surface of the hemisphere to the narrowest portion of jet (Vena contracta).

Vena contracta is narrowest portion of jet as emerges from tricuspid orifice.
The flow convergence zone is the zone of increased flow velocity before the regurgitant orifice.

It´s used to calculate: EROA.
A4C (RV focused)

Zoom mode (focused on tricuspid valve)

Mid-systole (ECG: The beginning of T wave).
Color doppler

Nyquist limit (Aliasing velocity): 30-40cm/s

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Chronic tricuspid regurgitation
	Mild	Moderate	Severe
Structural
Tricuspid valve morphology	Normal or mildly abnormal leaflets	Moderately abnormal leaflets	Severe valve lesions (e.g., flail leaflet, severe retraction, large perforation)
Right atrium (Size)	Usually normal (RA major <45mm)	Normal or mild dilatation	Usually dilated¹ (RA major >45mm)
Right ventricle (Size)	Usually normal (RVD1_basal <41mm)	Normal or mild dilatation	Usually dilated¹ (RVD1_basal >41mm)
IVC_diameter Inferior vena cava diameter	Normal (IVC_diameter <2cm)	Normal or mildly dilated (IVC_diameter 2,1 - 2,5cm)	Dilated (IVC_diameter >2,5cm)
Qualitative doppler
RegJet_area Regurgitation jet area. (Nyquist limit 50-70cm/s)	Small, narrow, central (RegJet/RA area <20%)	Moderate central	Large central jet (RegJet/RA area >50%) or eccentric wall-impinging jet of variable size
Flow convergence (PISAr) (Nyquist limit 30-40cm/s)	Not visible, transient or small (PISAr <0,3cm)	Intermediate in size and duration	Large throughout systole (PISAr ≥1cm)
Regurgitant jet (CW doppler)	Faint/ partial/ parabolic	Dense but partial or parabolic	Dense, often triangular
Semiquantitative
RegJet_area (cm²) Regurgitation jet area (Nyquist limit 50-70cm/s)	Not defined	Not defined	>10
VCW (cm) Vena contracta width (Nyquist limit 50-70cm/s)	<0,3	0,3 - 0,69	≥0,7
PISAr (cm) (Nyquist limit 30-40cm/s)	≤0,5	0,6 - 0,9	>0,9
Hepatic vein flow²	Systolic dominance	Systolic blunting	Systolic flow reversal
Tricuspid inflow²	A wave dominant (A wave > E wave)	Variable	E wave (E wave >1m/s)
Quantitative
EROA (cm²) Effective regurgitant orifice area	<0,2	0,2 - 0,39³	≥0,4
RegVol (ml) Regurgitant volume of tricuspid regurgitation	<30	30 - 44³	≥45

Bolded signs are considered specific for their tricuspid regurgitation grade.

RV and RA size can be within the ‘‘normal’’ range in patients with acute severe TR.
Signs are nonspecific and are influenced by many other factors (RV diastolic function, atrial fibrillation, RA pressure).
There are little data to support further separation of these values.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Va

Aliasing velocity

Manually set value on the echocardiography machine.
It´s used to calculate: EROA.
Nyquist limit: 50-70cm/s

Baseline is shifted in the direction of tricuspid regurgitation jet to 30-40cm/s.
Aliasing occurs: If the blood flow from the probe (blue) exceeds the Va speed (38.5cm/s).

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

Apical 4 chamber (A4C). Tricuspid valve CW doppler

Vmax TR

Peak tricuspidal regurgitation velocity

It´s used to calculate: EROA
A4C (RV focused)
Systole (ECG: R wave - The end of T wave).
CW doppler

Place the cursor between tricuspid leaflet tips.
Color doppler (helps with blood flow identification).

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

Tricuspid valve VCW (Vena contracta width)

VCW

Vena contracta width

Narrowest portion of jet as emerges from tricuspid orifice.
Vena contracta is diameter of EROA (Effective Regurgitant Orifice Area).
A4C (RV focused)

Zoom mode (focused on tricuspid valve).

Color doppler

Nyquist limit (Aliasing velocity): 50-70cm/s

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Chronic tricuspid regurgitation
	Mild	Moderate	Severe
Structural
Tricuspid valve morphology	Normal or mildly abnormal leaflets	Moderately abnormal leaflets	Severe valve lesions (e.g., flail leaflet, severe retraction, large perforation)
Right atrium (Size)	Usually normal (RA major <45mm)	Normal or mild dilatation	Usually dilated¹ (RA major >45mm)
Right ventricle (Size)	Usually normal (RVD1_basal <41mm)	Normal or mild dilatation	Usually dilated¹ (RVD1_basal >41mm)
IVC_diameter Inferior vena cava diameter	Normal (IVC_diameter <2cm)	Normal or mildly dilated (IVC_diameter 2,1 - 2,5cm)	Dilated (IVC_diameter >2,5cm)
Qualitative doppler
RegJet_area Regurgitation jet area. (Nyquist limit 50-70cm/s)	Small, narrow, central (RegJet/RA area <20%)	Moderate central	Large central jet (RegJet/RA area >50%) or eccentric wall-impinging jet of variable size
Flow convergence (PISAr) (Nyquist limit 30-40cm/s)	Not visible, transient or small (PISAr <0,3cm)	Intermediate in size and duration	Large throughout systole (PISAr ≥1cm)
Regurgitant jet (CW doppler)	Faint/ partial/ parabolic	Dense but partial or parabolic	Dense, often triangular
Semiquantitative
RegJet_area (cm²) Regurgitation jet area (Nyquist limit 50-70cm/s)	Not defined	Not defined	>10
VCW (cm) Vena contracta width (Nyquist limit 50-70cm/s)	<0,3	0,3 - 0,69	≥0,7
PISAr (cm) (Nyquist limit 30-40cm/s)	≤0,5	0,6 - 0,9	>0,9
Hepatic vein flow²	Systolic dominance	Systolic blunting	Systolic flow reversal
Tricuspid inflow²	A wave dominant (A wave > E wave)	Variable	E wave (E wave >1m/s)
Quantitative
EROA (cm²) Effective regurgitant orifice area	<0,2	0,2 - 0,39³	≥0,4
RegVol (ml) Regurgitant volume of tricuspid regurgitation	<30	30 - 44³	≥45

Bolded signs are considered specific for their tricuspid regurgitation grade.

RV and RA size can be within the ‘‘normal’’ range in patients with acute severe TR.
Signs are nonspecific and are influenced by many other factors (RV diastolic function, atrial fibrillation, RA pressure).
There are little data to support further separation of these values.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

VTI TR (Velocity time integral of tricuspidal regurgitant jet)

RegVol_TR = EROA x VTI TR

Regurgitant volume of tricuspidal regurgitation

Regurgitant volume of tricuspidal regurgitation.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Chronic tricuspid regurgitation
	Mild	Moderate	Severe
Structural
Tricuspid valve morphology	Normal or mildly abnormal leaflets	Moderately abnormal leaflets	Severe valve lesions (e.g., flail leaflet, severe retraction, large perforation)
Right atrium (Size)	Usually normal (RA major <45mm)	Normal or mild dilatation	Usually dilated¹ (RA major >45mm)
Right ventricle (Size)	Usually normal (RVD1_basal <41mm)	Normal or mild dilatation	Usually dilated¹ (RVD1_basal >41mm)
IVC_diameter Inferior vena cava diameter	Normal (IVC_diameter <2cm)	Normal or mildly dilated (IVC_diameter 2,1 - 2,5cm)	Dilated (IVC_diameter >2,5cm)
Qualitative doppler
RegJet_area Regurgitation jet area. (Nyquist limit 50-70cm/s)	Small, narrow, central (RegJet/RA area <20%)	Moderate central	Large central jet (RegJet/RA area >50%) or eccentric wall-impinging jet of variable size
Flow convergence (PISAr) (Nyquist limit 30-40cm/s)	Not visible, transient or small (PISAr <0,3cm)	Intermediate in size and duration	Large throughout systole (PISAr ≥1cm)
Regurgitant jet (CW doppler)	Faint/ partial/ parabolic	Dense but partial or parabolic	Dense, often triangular
Semiquantitative
RegJet_area (cm²) Regurgitation jet area (Nyquist limit 50-70cm/s)	Not defined	Not defined	>10
VCW (cm) Vena contracta width (Nyquist limit 50-70cm/s)	<0,3	0,3 - 0,69	≥0,7
PISAr (cm) (Nyquist limit 30-40cm/s)	≤0,5	0,6 - 0,9	>0,9
Hepatic vein flow²	Systolic dominance	Systolic blunting	Systolic flow reversal
Tricuspid inflow²	A wave dominant (A wave > E wave)	Variable	E wave (E wave >1m/s)
Quantitative
EROA (cm²) Effective regurgitant orifice area	<0,2	0,2 - 0,39³	≥0,4
RegVol (ml) Regurgitant volume of tricuspid regurgitation	<30	30 - 44³	≥45

Bolded signs are considered specific for their tricuspid regurgitation grade.

RV and RA size can be within the ‘‘normal’’ range in patients with acute severe TR.
Signs are nonspecific and are influenced by many other factors (RV diastolic function, atrial fibrillation, RA pressure).
There are little data to support further separation of these values.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

VTI TR

Velocity time integral of tricuspidal regurgitant jet

It´s used to calculate: RegVol_TR
A4C (RV focused)
Systole (ECG: R wave - The end of T wave)
CW doppler

Place the cursor between tricuspid leaflet tips.
Trace along the edge of the modal velocity to measure the area under the curve.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

RegJet_{soft density}

Regurgitant jet soft density

Density and contour of regurgitant jet

Density is proportional to the number of red blood cells reflecting the signal.

A4C (RV focused)

Zoom mode (focused on tricuspid valve)

Systole (ECG: R wave - The end of T wave)
CW doppler
Soft density suggests mild tricuspid regurgitation.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Chronic tricuspid regurgitation
	Mild	Moderate	Severe
Structural
Tricuspid valve morphology	Normal or mildly abnormal leaflets	Moderately abnormal leaflets	Severe valve lesions (e.g., flail leaflet, severe retraction, large perforation)
Right atrium (Size)	Usually normal (RA major <45mm)	Normal or mild dilatation	Usually dilated¹ (RA major >45mm)
Right ventricle (Size)	Usually normal (RVD1_basal <41mm)	Normal or mild dilatation	Usually dilated¹ (RVD1_basal >41mm)
IVC_diameter Inferior vena cava diameter	Normal (IVC_diameter <2cm)	Normal or mildly dilated (IVC_diameter 2,1 - 2,5cm)	Dilated (IVC_diameter >2,5cm)
Qualitative doppler
RegJet_area Regurgitation jet area. (Nyquist limit 50-70cm/s)	Small, narrow, central (RegJet/RA area <20%)	Moderate central	Large central jet (RegJet/RA area >50%) or eccentric wall-impinging jet of variable size
Flow convergence (PISAr) (Nyquist limit 30-40cm/s)	Not visible, transient or small (PISAr <0,3cm)	Intermediate in size and duration	Large throughout systole (PISAr ≥1cm)
Regurgitant jet (CW doppler)	Faint/ partial/ parabolic	Dense but partial or parabolic	Dense, often triangular
Semiquantitative
RegJet_area (cm²) Regurgitation jet area (Nyquist limit 50-70cm/s)	Not defined	Not defined	>10
VCW (cm) Vena contracta width (Nyquist limit 50-70cm/s)	<0,3	0,3 - 0,69	≥0,7
PISAr (cm) (Nyquist limit 30-40cm/s)	≤0,5	0,6 - 0,9	>0,9
Hepatic vein flow²	Systolic dominance	Systolic blunting	Systolic flow reversal
Tricuspid inflow²	A wave dominant (A wave > E wave)	Variable	E wave (E wave >1m/s)
Quantitative
EROA (cm²) Effective regurgitant orifice area	<0,2	0,2 - 0,39³	≥0,4
RegVol (ml) Regurgitant volume of tricuspid regurgitation	<30	30 - 44³	≥45

Bolded signs are considered specific for their tricuspid regurgitation grade.

RV and RA size can be within the ‘‘normal’’ range in patients with acute severe TR.
Signs are nonspecific and are influenced by many other factors (RV diastolic function, atrial fibrillation, RA pressure).
There are little data to support further separation of these values.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

RegJet_{hard density}

Regurgitant jet hard density

Density and contour of regurgitant jet.

Density is proportional to the number of red blood cells reflecting the signal.

A4C (RV focused)
Systole (ECG: R wave - The end of T wave)
CW doppler
Hard density suggests severe tricuspid regurgitation.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Chronic tricuspid regurgitation
	Mild	Moderate	Severe
Structural
Tricuspid valve morphology	Normal or mildly abnormal leaflets	Moderately abnormal leaflets	Severe valve lesions (e.g., flail leaflet, severe retraction, large perforation)
Right atrium (Size)	Usually normal (RA major <45mm)	Normal or mild dilatation	Usually dilated¹ (RA major >45mm)
Right ventricle (Size)	Usually normal (RVD1_basal <41mm)	Normal or mild dilatation	Usually dilated¹ (RVD1_basal >41mm)
IVC_diameter Inferior vena cava diameter	Normal (IVC_diameter <2cm)	Normal or mildly dilated (IVC_diameter 2,1 - 2,5cm)	Dilated (IVC_diameter >2,5cm)
Qualitative doppler
RegJet_area Regurgitation jet area. (Nyquist limit 50-70cm/s)	Small, narrow, central (RegJet/RA area <20%)	Moderate central	Large central jet (RegJet/RA area >50%) or eccentric wall-impinging jet of variable size
Flow convergence (PISAr) (Nyquist limit 30-40cm/s)	Not visible, transient or small (PISAr <0,3cm)	Intermediate in size and duration	Large throughout systole (PISAr ≥1cm)
Regurgitant jet (CW doppler)	Faint/ partial/ parabolic	Dense but partial or parabolic	Dense, often triangular
Semiquantitative
RegJet_area (cm²) Regurgitation jet area (Nyquist limit 50-70cm/s)	Not defined	Not defined	>10
VCW (cm) Vena contracta width (Nyquist limit 50-70cm/s)	<0,3	0,3 - 0,69	≥0,7
PISAr (cm) (Nyquist limit 30-40cm/s)	≤0,5	0,6 - 0,9	>0,9
Hepatic vein flow²	Systolic dominance	Systolic blunting	Systolic flow reversal
Tricuspid inflow²	A wave dominant (A wave > E wave)	Variable	E wave (E wave >1m/s)
Quantitative
EROA (cm²) Effective regurgitant orifice area	<0,2	0,2 - 0,39³	≥0,4
RegVol (ml) Regurgitant volume of tricuspid regurgitation	<30	30 - 44³	≥45

Bolded signs are considered specific for their tricuspid regurgitation grade.

RV and RA size can be within the ‘‘normal’’ range in patients with acute severe TR.
Signs are nonspecific and are influenced by many other factors (RV diastolic function, atrial fibrillation, RA pressure).
There are little data to support further separation of these values.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Dominant tricuspidal A wave (A wave > E wave)

Apical 4 chamber (A4C) PW doppler of tricuspid valve inflow

A wave_dominant

Dominant tricuspidal A wave (A wave > E wave)

A4C (RV focused).
Late-diastole (ECG: Right after P wave)
PW doppler.

Sample volume between tricuspid leaflet tips.

Suggest mild tricuspid regurgitation.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Chronic tricuspid regurgitation
	Mild	Moderate	Severe
Structural
Tricuspid valve morphology	Normal or mildly abnormal leaflets	Moderately abnormal leaflets	Severe valve lesions (e.g., flail leaflet, severe retraction, large perforation)
Right atrium (Size)	Usually normal (RA major <45mm)	Normal or mild dilatation	Usually dilated¹ (RA major >45mm)
Right ventricle (Size)	Usually normal (RVD1_basal <41mm)	Normal or mild dilatation	Usually dilated¹ (RVD1_basal >41mm)
IVC_diameter Inferior vena cava diameter	Normal (IVC_diameter <2cm)	Normal or mildly dilated (IVC_diameter 2,1 - 2,5cm)	Dilated (IVC_diameter >2,5cm)
Qualitative doppler
RegJet_area Regurgitation jet area. (Nyquist limit 50-70cm/s)	Small, narrow, central (RegJet/RA area <20%)	Moderate central	Large central jet (RegJet/RA area >50%) or eccentric wall-impinging jet of variable size
Flow convergence (PISAr) (Nyquist limit 30-40cm/s)	Not visible, transient or small (PISAr <0,3cm)	Intermediate in size and duration	Large throughout systole (PISAr ≥1cm)
Regurgitant jet (CW doppler)	Faint/ partial/ parabolic	Dense but partial or parabolic	Dense, often triangular
Semiquantitative
RegJet_area (cm²) Regurgitation jet area (Nyquist limit 50-70cm/s)	Not defined	Not defined	>10
VCW (cm) Vena contracta width (Nyquist limit 50-70cm/s)	<0,3	0,3 - 0,69	≥0,7
PISAr (cm) (Nyquist limit 30-40cm/s)	≤0,5	0,6 - 0,9	>0,9
Hepatic vein flow²	Systolic dominance	Systolic blunting	Systolic flow reversal
Tricuspid inflow²	A wave dominant (A wave > E wave)	Variable	E wave (E wave >1m/s)
Quantitative
EROA (cm²) Effective regurgitant orifice area	<0,2	0,2 - 0,39³	≥0,4
RegVol (ml) Regurgitant volume of tricuspid regurgitation	<30	30 - 44³	≥45

Bolded signs are considered specific for their tricuspid regurgitation grade.

RV and RA size can be within the ‘‘normal’’ range in patients with acute severe TR.
Signs are nonspecific and are influenced by many other factors (RV diastolic function, atrial fibrillation, RA pressure).
There are little data to support further separation of these values.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

RA major

Right atrium major axis dimension

Length of righ atrium
A4C (RV focused).
End-systole (ECG: The end of T wave).
Length from center of valve annulus to center of superior RA wall

Parallel to intraatrial septum.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Chronic tricuspid regurgitation
	Mild	Moderate	Severe
Structural
Tricuspid valve morphology	Normal or mildly abnormal leaflets	Moderately abnormal leaflets	Severe valve lesions (e.g., flail leaflet, severe retraction, large perforation)
Right atrium (Size)	Usually normal (RA major <45mm)	Normal or mild dilatation	Usually dilated¹ (RA major >45mm)
Right ventricle (Size)	Usually normal (RVD1_basal <41mm)	Normal or mild dilatation	Usually dilated¹ (RVD1_basal >41mm)
IVC_diameter Inferior vena cava diameter	Normal (IVC_diameter <2cm)	Normal or mildly dilated (IVC_diameter 2,1 - 2,5cm)	Dilated (IVC_diameter >2,5cm)
Qualitative doppler
RegJet_area Regurgitation jet area. (Nyquist limit 50-70cm/s)	Small, narrow, central (RegJet/RA area <20%)	Moderate central	Large central jet (RegJet/RA area >50%) or eccentric wall-impinging jet of variable size
Flow convergence (PISAr) (Nyquist limit 30-40cm/s)	Not visible, transient or small (PISAr <0,3cm)	Intermediate in size and duration	Large throughout systole (PISAr ≥1cm)
Regurgitant jet (CW doppler)	Faint/ partial/ parabolic	Dense but partial or parabolic	Dense, often triangular
Semiquantitative
RegJet_area (cm²) Regurgitation jet area (Nyquist limit 50-70cm/s)	Not defined	Not defined	>10
VCW (cm) Vena contracta width (Nyquist limit 50-70cm/s)	<0,3	0,3 - 0,69	≥0,7
PISAr (cm) (Nyquist limit 30-40cm/s)	≤0,5	0,6 - 0,9	>0,9
Hepatic vein flow²	Systolic dominance	Systolic blunting	Systolic flow reversal
Tricuspid inflow²	A wave dominant (A wave > E wave)	Variable	E wave (E wave >1m/s)
Quantitative
EROA (cm²) Effective regurgitant orifice area	<0,2	0,2 - 0,39³	≥0,4
RegVol (ml) Regurgitant volume of tricuspid regurgitation	<30	30 - 44³	≥45

Bolded signs are considered specific for their tricuspid regurgitation grade.

RV and RA size can be within the ‘‘normal’’ range in patients with acute severe TR.
Signs are nonspecific and are influenced by many other factors (RV diastolic function, atrial fibrillation, RA pressure).
There are little data to support further separation of these values.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Right atrium (Size)
Variable	Abnormal
RA major (mm) Right atrium major axis dimension	>53
RA minor (mm) Right atrium minor axis dimension	>44
RA area (cm²) Right atrial area	>18

Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the ASE and EACVI (2015)

RVD1_basal

Right ventricular basal diameter at end-diastole

RVD1 represents the RV’s widest diameter.
A4C (RV focused).
End-diastole (ECG: R wave).
It´s measured just above the tricuspid annulus.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Chronic tricuspid regurgitation
	Mild	Moderate	Severe
Structural
Tricuspid valve morphology	Normal or mildly abnormal leaflets	Moderately abnormal leaflets	Severe valve lesions (e.g., flail leaflet, severe retraction, large perforation)
Right atrium (Size)	Usually normal (RA major <45mm)	Normal or mild dilatation	Usually dilated¹ (RA major >45mm)
Right ventricle (Size)	Usually normal (RVD1_basal <41mm)	Normal or mild dilatation	Usually dilated¹ (RVD1_basal >41mm)
IVC_diameter Inferior vena cava diameter	Normal (IVC_diameter <2cm)	Normal or mildly dilated (IVC_diameter 2,1 - 2,5cm)	Dilated (IVC_diameter >2,5cm)
Qualitative doppler
RegJet_area Regurgitation jet area. (Nyquist limit 50-70cm/s)	Small, narrow, central (RegJet/RA area <20%)	Moderate central	Large central jet (RegJet/RA area >50%) or eccentric wall-impinging jet of variable size
Flow convergence (PISAr) (Nyquist limit 30-40cm/s)	Not visible, transient or small (PISAr <0,3cm)	Intermediate in size and duration	Large throughout systole (PISAr ≥1cm)
Regurgitant jet (CW doppler)	Faint/ partial/ parabolic	Dense but partial or parabolic	Dense, often triangular
Semiquantitative
RegJet_area (cm²) Regurgitation jet area (Nyquist limit 50-70cm/s)	Not defined	Not defined	>10
VCW (cm) Vena contracta width (Nyquist limit 50-70cm/s)	<0,3	0,3 - 0,69	≥0,7
PISAr (cm) (Nyquist limit 30-40cm/s)	≤0,5	0,6 - 0,9	>0,9
Hepatic vein flow²	Systolic dominance	Systolic blunting	Systolic flow reversal
Tricuspid inflow²	A wave dominant (A wave > E wave)	Variable	E wave (E wave >1m/s)
Quantitative
EROA (cm²) Effective regurgitant orifice area	<0,2	0,2 - 0,39³	≥0,4
RegVol (ml) Regurgitant volume of tricuspid regurgitation	<30	30 - 44³	≥45

Bolded signs are considered specific for their tricuspid regurgitation grade.

RV and RA size can be within the ‘‘normal’’ range in patients with acute severe TR.
Signs are nonspecific and are influenced by many other factors (RV diastolic function, atrial fibrillation, RA pressure).
There are little data to support further separation of these values.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Right ventricle (Size)
RVD1_basal Right ventricular basal diameter at end-diastole	25 - 41mm
RVD2_mid Right ventricular mid diameter at end-diastole	19 - 35mm
RVD3_long Right ventricular longitudinal diameter at end-diastole	59 - 83mm
RVOT_prox(PLAX) Right ventricular outflow tract at proximal (PLAX)	20 - 30mm
RVOT_prox(PSAX) Right ventricular outflow tract at proximal (PSAX)	21 - 35mm
RVOT_distal(PSAX) Right ventricular outflow tract at distal (PSAX)	17 - 27mm
PA_diameter Main pulmonary artery diameter	15 - 25mm
RVWT Right ventricular wall thickness	1 - 5mm

Guidelines for the Echocardiographic Assessment of the Right Heart in Adults: ASE, EACVI, ESC, CSE (2010)

Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the ASE and EACVI (2015)

Guidelines for the diagnosis and management of acute pulmonary embolism ESC, ERS (2019)

TV_annulus

Tricuspid valve annulus diameter

A4C (RV focused)

Zoom mode (focused on tricuspid valve)

End-diastole (ECG: R wave)
The dilated tricuspid annulus suggests severe tricuspid regurgitation.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Chronic tricuspid regurgitation
	Mild	Moderate	Severe
Structural
Tricuspid valve morphology	Normal or mildly abnormal leaflets	Moderately abnormal leaflets	Severe valve lesions (e.g., flail leaflet, severe retraction, large perforation)
Right atrium (Size)	Usually normal (RA major <45mm)	Normal or mild dilatation	Usually dilated¹ (RA major >45mm)
Right ventricle (Size)	Usually normal (RVD1_basal <41mm)	Normal or mild dilatation	Usually dilated¹ (RVD1_basal >41mm)
IVC_diameter Inferior vena cava diameter	Normal (IVC_diameter <2cm)	Normal or mildly dilated (IVC_diameter 2,1 - 2,5cm)	Dilated (IVC_diameter >2,5cm)
Qualitative doppler
RegJet_area Regurgitation jet area. (Nyquist limit 50-70cm/s)	Small, narrow, central (RegJet/RA area <20%)	Moderate central	Large central jet (RegJet/RA area >50%) or eccentric wall-impinging jet of variable size
Flow convergence (PISAr) (Nyquist limit 30-40cm/s)	Not visible, transient or small (PISAr <0,3cm)	Intermediate in size and duration	Large throughout systole (PISAr ≥1cm)
Regurgitant jet (CW doppler)	Faint/ partial/ parabolic	Dense but partial or parabolic	Dense, often triangular
Semiquantitative
RegJet_area (cm²) Regurgitation jet area (Nyquist limit 50-70cm/s)	Not defined	Not defined	>10
VCW (cm) Vena contracta width (Nyquist limit 50-70cm/s)	<0,3	0,3 - 0,69	≥0,7
PISAr (cm) (Nyquist limit 30-40cm/s)	≤0,5	0,6 - 0,9	>0,9
Hepatic vein flow²	Systolic dominance	Systolic blunting	Systolic flow reversal
Tricuspid inflow²	A wave dominant (A wave > E wave)	Variable	E wave (E wave >1m/s)
Quantitative
EROA (cm²) Effective regurgitant orifice area	<0,2	0,2 - 0,39³	≥0,4
RegVol (ml) Regurgitant volume of tricuspid regurgitation	<30	30 - 44³	≥45

Bolded signs are considered specific for their tricuspid regurgitation grade.

RV and RA size can be within the ‘‘normal’’ range in patients with acute severe TR.
Signs are nonspecific and are influenced by many other factors (RV diastolic function, atrial fibrillation, RA pressure).
There are little data to support further separation of these values.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Ratio regurgitant jet area and right atrium - RA area

RegJet/RA area = RegJet_area / RA area x 100

Ratio RegJet_area / RA area

Ratio area of the jet to the right atrium area.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Chronic tricuspid regurgitation
	Mild	Moderate	Severe
Structural
Tricuspid valve morphology	Normal or mildly abnormal leaflets	Moderately abnormal leaflets	Severe valve lesions (e.g., flail leaflet, severe retraction, large perforation)
Right atrium (Size)	Usually normal (RA major <45mm)	Normal or mild dilatation	Usually dilated¹ (RA major >45mm)
Right ventricle (Size)	Usually normal (RVD1_basal <41mm)	Normal or mild dilatation	Usually dilated¹ (RVD1_basal >41mm)
IVC_diameter Inferior vena cava diameter	Normal (IVC_diameter <2cm)	Normal or mildly dilated (IVC_diameter 2,1 - 2,5cm)	Dilated (IVC_diameter >2,5cm)
Qualitative doppler
RegJet_area Regurgitation jet area. (Nyquist limit 50-70cm/s)	Small, narrow, central (RegJet/RA area <20%)	Moderate central	Large central jet (RegJet/RA area >50%) or eccentric wall-impinging jet of variable size
Flow convergence (PISAr) (Nyquist limit 30-40cm/s)	Not visible, transient or small (PISAr <0,3cm)	Intermediate in size and duration	Large throughout systole (PISAr ≥1cm)
Regurgitant jet (CW doppler)	Faint/ partial/ parabolic	Dense but partial or parabolic	Dense, often triangular
Semiquantitative
RegJet_area (cm²) Regurgitation jet area (Nyquist limit 50-70cm/s)	Not defined	Not defined	>10
VCW (cm) Vena contracta width (Nyquist limit 50-70cm/s)	<0,3	0,3 - 0,69	≥0,7
PISAr (cm) (Nyquist limit 30-40cm/s)	≤0,5	0,6 - 0,9	>0,9
Hepatic vein flow²	Systolic dominance	Systolic blunting	Systolic flow reversal
Tricuspid inflow²	A wave dominant (A wave > E wave)	Variable	E wave (E wave >1m/s)
Quantitative
EROA (cm²) Effective regurgitant orifice area	<0,2	0,2 - 0,39³	≥0,4
RegVol (ml) Regurgitant volume of tricuspid regurgitation	<30	30 - 44³	≥45

Bolded signs are considered specific for their tricuspid regurgitation grade.

RV and RA size can be within the ‘‘normal’’ range in patients with acute severe TR.
Signs are nonspecific and are influenced by many other factors (RV diastolic function, atrial fibrillation, RA pressure).
There are little data to support further separation of these values.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

RegJet_area

Regurgitation jet area

It´s used to calculate: RegJet/RA area
A4C (RV focused)

Zoom mode (focused on tricuspid valve)

Systole (ECG: R wave - The end of T wave)
Color doppler

Nyquist limit (Aliasing velocity): 50-70cm/s

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Chronic tricuspid regurgitation
	Mild	Moderate	Severe
Structural
Tricuspid valve morphology	Normal or mildly abnormal leaflets	Moderately abnormal leaflets	Severe valve lesions (e.g., flail leaflet, severe retraction, large perforation)
Right atrium (Size)	Usually normal (RA major <45mm)	Normal or mild dilatation	Usually dilated¹ (RA major >45mm)
Right ventricle (Size)	Usually normal (RVD1_basal <41mm)	Normal or mild dilatation	Usually dilated¹ (RVD1_basal >41mm)
IVC_diameter Inferior vena cava diameter	Normal (IVC_diameter <2cm)	Normal or mildly dilated (IVC_diameter 2,1 - 2,5cm)	Dilated (IVC_diameter >2,5cm)
Qualitative doppler
RegJet_area Regurgitation jet area. (Nyquist limit 50-70cm/s)	Small, narrow, central (RegJet/RA area <20%)	Moderate central	Large central jet (RegJet/RA area >50%) or eccentric wall-impinging jet of variable size
Flow convergence (PISAr) (Nyquist limit 30-40cm/s)	Not visible, transient or small (PISAr <0,3cm)	Intermediate in size and duration	Large throughout systole (PISAr ≥1cm)
Regurgitant jet (CW doppler)	Faint/ partial/ parabolic	Dense but partial or parabolic	Dense, often triangular
Semiquantitative
RegJet_area (cm²) Regurgitation jet area (Nyquist limit 50-70cm/s)	Not defined	Not defined	>10
VCW (cm) Vena contracta width (Nyquist limit 50-70cm/s)	<0,3	0,3 - 0,69	≥0,7
PISAr (cm) (Nyquist limit 30-40cm/s)	≤0,5	0,6 - 0,9	>0,9
Hepatic vein flow²	Systolic dominance	Systolic blunting	Systolic flow reversal
Tricuspid inflow²	A wave dominant (A wave > E wave)	Variable	E wave (E wave >1m/s)
Quantitative
EROA (cm²) Effective regurgitant orifice area	<0,2	0,2 - 0,39³	≥0,4
RegVol (ml) Regurgitant volume of tricuspid regurgitation	<30	30 - 44³	≥45

Bolded signs are considered specific for their tricuspid regurgitation grade.

RV and RA size can be within the ‘‘normal’’ range in patients with acute severe TR.
Signs are nonspecific and are influenced by many other factors (RV diastolic function, atrial fibrillation, RA pressure).
There are little data to support further separation of these values.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

RA area

Right atrial area

It´s used to calculate: RegJet/RA area
A4C (RV focused)

Zoom mode (focused on tricuspid valve)

End-systole (ECG: The end of T wave).
Color doppler

Nyquist limit (Aliasing velocity): 50-70cm/s

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

SC window (Hepatic vein) PW doppler of hepatic vein

HV_{reversal flow}

Hepatic vein reversal flow

Hepatic vein reversal flow during systole
SC window (Hepatic vein)
Systole (ECG: R wave - The end of T wave)
PW doppler

Sample volume from hepatal vein.

Suggests severe tricuspid regurgitation

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Chronic tricuspid regurgitation
	Mild	Moderate	Severe
Structural
Tricuspid valve morphology	Normal or mildly abnormal leaflets	Moderately abnormal leaflets	Severe valve lesions (e.g., flail leaflet, severe retraction, large perforation)
Right atrium (Size)	Usually normal (RA major <45mm)	Normal or mild dilatation	Usually dilated¹ (RA major >45mm)
Right ventricle (Size)	Usually normal (RVD1_basal <41mm)	Normal or mild dilatation	Usually dilated¹ (RVD1_basal >41mm)
IVC_diameter Inferior vena cava diameter	Normal (IVC_diameter <2cm)	Normal or mildly dilated (IVC_diameter 2,1 - 2,5cm)	Dilated (IVC_diameter >2,5cm)
Qualitative doppler
RegJet_area Regurgitation jet area. (Nyquist limit 50-70cm/s)	Small, narrow, central (RegJet/RA area <20%)	Moderate central	Large central jet (RegJet/RA area >50%) or eccentric wall-impinging jet of variable size
Flow convergence (PISAr) (Nyquist limit 30-40cm/s)	Not visible, transient or small (PISAr <0,3cm)	Intermediate in size and duration	Large throughout systole (PISAr ≥1cm)
Regurgitant jet (CW doppler)	Faint/ partial/ parabolic	Dense but partial or parabolic	Dense, often triangular
Semiquantitative
RegJet_area (cm²) Regurgitation jet area (Nyquist limit 50-70cm/s)	Not defined	Not defined	>10
VCW (cm) Vena contracta width (Nyquist limit 50-70cm/s)	<0,3	0,3 - 0,69	≥0,7
PISAr (cm) (Nyquist limit 30-40cm/s)	≤0,5	0,6 - 0,9	>0,9
Hepatic vein flow²	Systolic dominance	Systolic blunting	Systolic flow reversal
Tricuspid inflow²	A wave dominant (A wave > E wave)	Variable	E wave (E wave >1m/s)
Quantitative
EROA (cm²) Effective regurgitant orifice area	<0,2	0,2 - 0,39³	≥0,4
RegVol (ml) Regurgitant volume of tricuspid regurgitation	<30	30 - 44³	≥45

Bolded signs are considered specific for their tricuspid regurgitation grade.

RV and RA size can be within the ‘‘normal’’ range in patients with acute severe TR.
Signs are nonspecific and are influenced by many other factors (RV diastolic function, atrial fibrillation, RA pressure).
There are little data to support further separation of these values.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

HV_{forward flow}

Hepatic vein forward flow

Dominant systolic flow (nonreversal, to the VCI) in hepatic vein during systole.
SC window (Hepatic vein)
Systole (ECG: R wave - The end of T wave)
PW doppler

Sample volume from hepatal vein.

Suggests mild tricuspid regurgitation

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

Chronic tricuspid regurgitation
	Mild	Moderate	Severe
Structural
Tricuspid valve morphology	Normal or mildly abnormal leaflets	Moderately abnormal leaflets	Severe valve lesions (e.g., flail leaflet, severe retraction, large perforation)
Right atrium (Size)	Usually normal (RA major <45mm)	Normal or mild dilatation	Usually dilated¹ (RA major >45mm)
Right ventricle (Size)	Usually normal (RVD1_basal <41mm)	Normal or mild dilatation	Usually dilated¹ (RVD1_basal >41mm)
IVC_diameter Inferior vena cava diameter	Normal (IVC_diameter <2cm)	Normal or mildly dilated (IVC_diameter 2,1 - 2,5cm)	Dilated (IVC_diameter >2,5cm)
Qualitative doppler
RegJet_area Regurgitation jet area. (Nyquist limit 50-70cm/s)	Small, narrow, central (RegJet/RA area <20%)	Moderate central	Large central jet (RegJet/RA area >50%) or eccentric wall-impinging jet of variable size
Flow convergence (PISAr) (Nyquist limit 30-40cm/s)	Not visible, transient or small (PISAr <0,3cm)	Intermediate in size and duration	Large throughout systole (PISAr ≥1cm)
Regurgitant jet (CW doppler)	Faint/ partial/ parabolic	Dense but partial or parabolic	Dense, often triangular
Semiquantitative
RegJet_area (cm²) Regurgitation jet area (Nyquist limit 50-70cm/s)	Not defined	Not defined	>10
VCW (cm) Vena contracta width (Nyquist limit 50-70cm/s)	<0,3	0,3 - 0,69	≥0,7
PISAr (cm) (Nyquist limit 30-40cm/s)	≤0,5	0,6 - 0,9	>0,9
Hepatic vein flow²	Systolic dominance	Systolic blunting	Systolic flow reversal
Tricuspid inflow²	A wave dominant (A wave > E wave)	Variable	E wave (E wave >1m/s)
Quantitative
EROA (cm²) Effective regurgitant orifice area	<0,2	0,2 - 0,39³	≥0,4
RegVol (ml) Regurgitant volume of tricuspid regurgitation	<30	30 - 44³	≥45

Bolded signs are considered specific for their tricuspid regurgitation grade.

RV and RA size can be within the ‘‘normal’’ range in patients with acute severe TR.
Signs are nonspecific and are influenced by many other factors (RV diastolic function, atrial fibrillation, RA pressure).
There are little data to support further separation of these values.

ASE Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation (2017)

RVOT diastal (Right ventricular outflow tract dimension at distal)

RVOT VTI (Velocity time integral of right ventricular outflow tract)

SV_PV = CSA_RVOT x VTI_RVOT

Stroke volume of pulmonary valve

It´s used to calculate: TrVA
Stroke volume of pulmonary valve is the same as stroke volume of tricuspid valve.

If no tricuspid regurgitation is present

Calculate it in the top menu: PV

Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice (2009)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

VTI TV (Velocity time integral of tricuspid valve - inflow)

RV modified apical 4 chamber (A4C) CW doppler of tricuspid valve inflow

VTI TrV

Velocity time integral of tricuspid valve (inflow)

It´s used to calculate: TrVA
A4C (RV focused)
Diastole (ECG: The end of T wave - R wave)
CW doppler

Place the cursor in the middle of tricuspid valve.

Trace along the edge of the modal velocity to measure the area under the curve.

Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice (2009)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

Tricuspid stenosis
Variable	Abnormal
meanPG TrV* Mean pressure gradient tricuspidal valve	≥5mmHg
VTI TrV* Velocity time integral of tricuspid valve (inflow)	>60cm
PHT TrV* Pressure half time of tricuspidal valve	≥190ms
TrVA* Tricuspid valve area (continuity equation)	≤1cm²
RA major Right atrium major axis dimension	>50mm
IVC_diameter Inferior vena cava diameter	>2,1cm

* Specific findings

Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice (2009)

meanPG TV (Mean pressure gradient tricuspidal valve)

meanPG TrV

Mean pressure gradient tricuspidal valve

A4C (RV focused)
Diastole (ECG: The end of T wave - R wave)
CW doppler

Place the cursor in the middle of tricuspid valve.
Trace along the edge of the modal velocity (inflow) to measure the area under the curve.

Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice (2009)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

Tricuspid stenosis
Variable	Abnormal
meanPG TrV* Mean pressure gradient tricuspidal valve	≥5mmHg
VTI TrV* Velocity time integral of tricuspid valve (inflow)	>60cm
PHT TrV* Pressure half time of tricuspidal valve	≥190ms
TrVA* Tricuspid valve area (continuity equation)	≤1cm²
RA major Right atrium major axis dimension	>50mm
IVC_diameter Inferior vena cava diameter	>2,1cm

* Specific findings

Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice (2009)

PHT TV (Pressure half time of tricuspidal valve)

PHT TrV

Pressure half time of tricuspidal valve

Pressure half-time (PHT) is defined as the time interval in milliseconds between the maximum gradient and the time point where the gradient is half the maximum initial value.
A4C (RV focused)
Diastole (ECG: The end of T wave - R wave)
CW doppler

Place the cursor in the middle of tricuspid valve.

PHT is obtained by tracing the deceleration slope.

Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice (2009)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

Tricuspid stenosis
Variable	Abnormal
meanPG TrV* Mean pressure gradient tricuspidal valve	≥5mmHg
VTI TrV* Velocity time integral of tricuspid valve (inflow)	>60cm
PHT TrV* Pressure half time of tricuspidal valve	≥190ms
TrVA* Tricuspid valve area (continuity equation)	≤1cm²
RA major Right atrium major axis dimension	>50mm
IVC_diameter Inferior vena cava diameter	>2,1cm

* Specific findings

Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice (2009)

Right ventricular outflow tract dimension at distal

Velocity time integral of right ventricular outflow tract

Velocity time integral of tricuspid valve (inflow)

TrVA = SV_PV / VTI TrV

Tricuspid valve area (continuity equation)

TrVA is underestimated if moderate or severe tricuspid regurgitation is present.

Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice (2009)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

Tricuspid stenosis
Variable	Abnormal
meanPG TrV* Mean pressure gradient tricuspidal valve	≥5mmHg
VTI TrV* Velocity time integral of tricuspid valve (inflow)	>60cm
PHT TrV* Pressure half time of tricuspidal valve	≥190ms
TrVA* Tricuspid valve area (continuity equation)	≤1cm²
RA major Right atrium major axis dimension	>50mm
IVC_diameter Inferior vena cava diameter	>2,1cm

* Specific findings

Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice (2009)

SC (subcostal view) long axis inferior vena cava IVC.

IVC_diameter

Inferior vena cava diameter

Maxiumum inferior vena cava diameter.
SC window (long axis IVC).
Measured perpendicular to the long axis of the IVC at end-expiration.

Just proximal to the junction of the hepatic veins that lie
approximately 1-3cm proximal to the ostium of the right atrium.

Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice (2009)

Guidelines for performing a comprehensive TTE examination in adults: Recommendations from the ASE (2018)

Tricuspid stenosis
Variable	Abnormal
meanPG TrV* Mean pressure gradient tricuspidal valve	≥5mmHg
VTI TrV* Velocity time integral of tricuspid valve (inflow)	>60cm
PHT TrV* Pressure half time of tricuspidal valve	≥190ms
TrVA* Tricuspid valve area (continuity equation)	≤1cm²
RA major Right atrium major axis dimension	>50mm
IVC_diameter Inferior vena cava diameter	>2,1cm

* Specific findings

Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice (2009)

Inferior vena cava (Size)
Variable	Abnormal
IVC_diameter Inferior vena cava diameter	>2,1cm

Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the ASE and EACVI (2015)

Echocardiography

Tricuspid valve

Va

VCW

PISAr

Vmax TR

EROA

VTI TR

RegVolTR

RegJetsoft density

RegJethard density

A wavedominant

RA major

RVD1basal

TVannulus

RegJetarea

RA area

RegJet/RA area

HVreversal flow

HVforward flow

SVPV

VTI TrV

TrVA

meanPG TrV

PHT TrV

IVCdiameter

EROA = 2π x PISAr2 x Va / Vmax TR

PISAr

Va

Vmax TR

VCW

RegVolTR = EROA x VTI TR

VTI TR

RegJetsoft density

RegJethard density

A wavedominant

RA major

RVD1basal

TVannulus

RegJet/RA area = RegJetarea / RA area x 100

RegJetarea

RA area

HVreversal flow

HVforward flow

SVPV = CSARVOT x VTIRVOT

VTI TrV

meanPG TrV

PHT TrV

TrVA = SVPV / VTI TrV

IVCdiameter

RegVol_TR

RegJet_{soft density}

RegJet_{hard density}

A wave_dominant

RVD1_basal

TV_annulus

RegJet_area

HV_{reversal flow}

HV_{forward flow}

SV_PV

IVC_diameter

EROA = 2π x PISAr² x Va / Vmax TR

RegVol_TR = EROA x VTI TR

RegJet_{soft density}

RegJet_{hard density}

A wave_dominant

RVD1_basal

TV_annulus

RegJet/RA area = RegJet_area / RA area x 100

RegJet_area

HV_{reversal flow}

HV_{forward flow}

SV_PV = CSA_RVOT x VTI_RVOT

TrVA = SV_PV / VTI TrV

IVC_diameter