Tricuspid Regurgitation: The Importance of Combining Two-Dimensional Echocardiography, Color Flow Imaging, and Contrast-Enhanced Continuous Wave Doppler in Assessment of Severity

A complete noninvasive assessment of patients with suspected tricuspid regurgitation should include two-dimensional echocardiography, color flow imaging, and continuous wave Doppler. Two-dimensional echocardiography may be used to demonstrate abnormalities in tricuspid valve morphology as well as changes in right heart size and function due to tricuspid regurgitation. Color flow imaging provides a semiquantitative method for determining the presence and extent of tricuspid regurgitant jet area. When tricuspid regurgitation is present, continuous wave Doppler is used to measure right ventricular (or pulmonary artery) systolic pressure by means of the modified Bernoulli equation of 4 X regurgitant jet velocity2 plus an assumption of the value of right artrial pressure. Contrast-enhancement of tricuspid regurgitant jet signals may be necessary if continuous wave Doppler does not delineate the jet envelope.