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.
1. DePace NL, Ross J, Iskandrian AS, et al: Tricuspid regurgitation: Noninvasive techniques for determining cause and severity. J Am Coll Cardiol1984; 3:1540-1550.
2.
2. Meltzer RS, Vered Z, Benjamin P, Hegesh J, Visser CA, Neufeld HN: Diagnosing tricuspid regurgitation by direct imaging of the regurgitant flow in the right atrium using contrast echocardiography. Am j Cardiol1983;52:1050-1053.
3.
3. Curtius JM, Thyssen M, Breuer HM, Loogen F: Doppler versus contrast echocardiography for diagnosis of tricuspid regurgitation. Am J Cardiol1985;56:333-336.
4.
4. Waggoner AD, Quinones MA, Young JB, et al: Pulsed Doppler echocardiographic detection of right sided valvular regurgitation. Am J Cardiol1981;47:279-286.
5.
5. Miyatake K, Okamoto M, Kinoshita N, et al: Evaluation of tricuspid regurgitation by pulsed Doppler and two-dimensional echocardiography. Circulation1982;66:777-784.
6.
6. Martin GR, Silverman NH, Soifer SJ, Lutin WA, Scagnelli SA: Tricuspid regurgitation in children: A pulsed Doppler, contrast echocardiographic and angiographic comparison. J Am Soc Echol988;1:257-263.
7.
7. Suzuki Y, Kambara H, Kadota K, et al: Detection and evaluation of tricuspid regurgitation using a real time, two-dimensional, color-coded, Doppler flow imaging system: Comparison with contrast two-dimensional echocardiography and right ventriculography. Am J Cardiol1986;57:811-815.
8.
8. Pollak SJ, McMillan SA, Knopff WD, Wharff R, Yoganathan AP, Felner JM: Cardiac evaluation of women distance runners by echocardiographic color Doppler flow mapping. J Am Coll Cardiol1988;11:89-93.
9.
9. Wittlich N, Erbel R, Drexler M, Mohr-Kahaly S, Brenneke R, Meyer J: Color Doppler flow mapping of the heart in normal subjects. Echocardiography1988;5:157-172.
10.
10. Bolger AF, Eigler NL, Maurer G: Quantifying valvular regurgitation. Limitations and inherent assumptions of Doppler techniques (editorial). Circulation1988;78:1316-1318.
11.
11. Currie PJ, Seward JB, Chan K, et al: Continuous wave Dopper determination of right ventricular pressure: A simultaneous Doppler-catheterization study in 127 patients. J Am Coll Cardiol1985;6:750-752.
12.
12. Berger M, Haimowitz A, Van Tosh A, Berdoff RL, Goldberg E: Quantitative assessment of pulmonary hypertension in patients with tricuspid regurgitation using continuous wave Doppler ultrasound. J Am Coll Cardiol1985;6:359-365.
13.
13. Skjaerpe T, Hatle L: Non-invasive estimation of systolic pressure in the right ventricle in patients with tricuspid regurgitation. Eur Heart J1986;7:704-710.
14.
14. King ME, Braun H, Goldblatt A, Liberthson R, Weyman AE: Interventricular septal configuration as a predictor of right ventricular systolic pressure in children: A cross-sectional echocardiographic study. Circulation1983;68:68-74.
15.
15. Simonson JS, Schiller NB: Sonospirometry. A new method for noninvasive estimation of mean right atrial pressure based on two-dimensional echocardiographic measurements of the inferior vena cava during measured inspiration. J Am Coll Cardiol1988;11:557-564.
16.
16. Moreno FL, Hagan AD, Holmon JR, Pryor TA, Strickland RD, Castle CH: Evaluation of size and dynamics of the inferior vena cava as an index of right sided cardiac function. Am J Cardiol1984;53:579-585.
