Tricuspid valve – trileaflet made up of anteiror/posterior/septal leaflets.

PSAX – septal leaflet by AV. Anterior leaflet is other visible.

PLAX RV Inflow – anterior leaflet is nearest probe. Posterior is other visible. Can modify to see septal rather than posterior leaflet.

A4C – septal leaflet by septum. Anterior leaflet by RV free wall.

3 papillary muscles, one inserts into septum.

A lot of disagreement re: anatomy. BSE article in 2014 states the above which will therefore be needed for exam.

Some degree of TR is present in 70-80% of studies making estimation of RVSP and PASP possible in most. Particularly ventilated patients.

Remember to look at structure of valve, whole valve apparatus (annulus, papillary muscles and chordae), not just the leaflets.

Many causes of TV disease – annular dilation. endocarditis, carcinoid, congenital, drugs, pacemaker, trauma, RV myopathy/infarct, pul htn.

Assessment:

Overall the assessment is much like mitral regurgitation.

2D to assess structure etc.

Colour:

Parasternal and apical views to assess the size and direction of tricuspid jet.

Trace jet area in A4C.

Vena contracta ensuring Nyquist limit 50-60cm/s.

PISA – Nyquist 20-40cm/s. Refer to MR section for more details on PISA. Make sure you have good alignment etc.

CW:

CW doppler trace of regurgitation. Ensure good alignment.

VIsual assessment of trace – soft/parabolic or dense/triangular with early peak.

Peak velocity of TR jet used to calculate PASP.

PW:

Used to measure blood flow within hepatic vein – ideally central hepatic vein. Subcostal window.

Hepatic vein flow normally directed towards throughout cardiac cycle, with systolic component being predominant.

In moderate TR systolic hepatic hepatic vein flow becomes blunted.

In severe TR systolic hepatic vein flow is reversed.

Article explaining doppler waveform of hepatic veins: https://pubs.rsna.org/doi/pdf/10.1148/rg.297095715