Tricuspid valve


The tricuspid valve ensures that there is no backflow from the right ventricle to the right atrium during systole. The tricuspid valve, as its Latin name suggests, consists of three leaflets: the septal (S), the anterior (A) and posterior (P) leaflets, of which the anterior leaflet is the largest. The tricuspid valve is distinguished not only by the number of valve leaflets as compared to mitral valve, but also by its method of attachment. The mitral valve chordae attach to only two papillary muscle heads where the chordae of tricuspid attach to much more muscle heads and also directly into the interventricular septum. The valve is located slightly more towards the apex as compared to the mitral valve.

Cross section of heart valves


Quantification of tricuspid regurgitation

Hepatic vein flowsyst. dominantsyst. decreasesyst. flow reversal
Vena contracta (mm)<7>7
PISA (cm²)< 0.60.6 - 0.9> 0.9
Density CW signallichtdensdens
Contour CW signalparabolicvariabletriangular
TR jet / RA area* (%)< 2020 - 34> 35
* The size of the color-doppler surface in right atrium is only a rough impression.

Echocardiographic criteria for the definition of severe tricuspid valve regurgitation: an integrative approuch.

Valve morphologyAbnormal/flail/large coaptation defect
Colour flow regurgitant jetVery large central jet or eccentric wall impinging jet *
CW signal of regurgitant jetDense/triangular with early peaking (peak <2 m/s in massive TR)
Vena contracta width (mm)≥ 7 *
Upstream vein flowSystolic hepatic vein flow reversal
InflowE-wave dominant ≥ 1 m/s **
PISA radius (mm)> 9 ***
EROA (mm²)≥ 40
Regugitant volume (mL/beat)≥ 45
Enlargement of cardiac chamber/vesselsRV, RA, IVC
* At Nyquist limit of 50-60 cm/s.
** In the absence of other causes of elevated LA pressure
*** Baseline Nyquist limit shift of 28 cm/s.

Outcome-based cut-off values for the quantitative parameters used to grade tricuspid regurgitation severity by Dopplerechocardiography.  
VariableLow riskIntermediate riskHigh risk
VC (mm)<33 - 6>6
EROA (cm²)<0.150.15 - 0.30>0.30
RegVol (ml)<1515 - 30>30
RegFR (%)<2525 - 45>45
EROA, effective regurgitant orifice area; RegFr, regurgitant fraction; RegVol, regurgitant volume; VCavg, vena contracta width.
Eur Heart J Cardiovasc Imaging (2021) 22, 155-165
Proposed expansion of the ‘Severe’ grade
VC (mm)<33 - 6.97 - 1314 - 20≥21
EROA (cm²)<0.200.20 - 0.390.40 - 0.590.60 - 0.79≥80
3D VCA or quantitative EROAa (cm²)*0.75 - 0.940.95 - 1.14≥1.15
VC, vena contracta; EROA, effective regurgitant orifice area; 3D VCA, three-dimensional vena contracta area.
*3D VCA and quantitative Doppler EROA cut-offs may be larger than PISA EROA.
Eur Heart J Cardiovasc Imaging (2017) 18, 1342–1343

TR vena contracta

Causes of tricuspid regurgitation

Functional TRSecundary TR
Disorders of the right ventricle: RV infarction, dilated cardiomyopathyEbstein anomaly
Secondary to pulmonary hypertension, for example: cor pulmonale, pulmonary embolism, or primary.Infective Endocarditis
Mitral stenosis or mitral regurgitationTrauma
Left-right shunt, such as an atrial septal defect or a ventricular septal defectRheumatic fever
Eisenmenger syndrome (rare)Carcinoid
Pulmonary stenosisPapillary muscle disorders
HyperthyroidismConnective tissue diseases such as Marfan Syndrome.
Non-infectious endocarditis, such as SLE or rheumatoid arthritis
Damage from the electrode of a pacemaker or ICD


Tricuspid valve stenosis is usually caused by rheumatic fever which mostly occurs during childhood. The rarely reported second causes of tricuspid valve stenosis include tumour obstruction, carcinoid disease and obstructed tricuspid valve prosthesis.

Quantification of tricuspid stenosis

TVA (cm²)< 1
PHT (ms)> 190
PGmean (mmHg)> 5
VTI (cm)> 60


Eur J Echocardiogr. 2009 Jan;10(1):1-25

Eur J Echocardiogr. 2010 May;11(4):307-32

European Heart Journal (2017) 00, 1?53

European Heart Journal - Cardiovascular Imaging (2017) 18, 1342–1343

European Heart Journal - Cardiovascular Imaging (2021) 22, 155–165