Tricuspid Regurgitation

Tricuspid regurgitation is the backward flow of blood from the RV into the RA during systole, caused by incomplete closure of the tricuspid valve. Chronic TR can lead to RA dilation, RV dysfunction, and signs of volume overload (e.g., elevated JVP, liver congestion, peripheral edema). Etiologies of TR can be divided into:

Primary TR = caused by structural pathology of the tricuspid valve itself (ie Rheumatic heart disease, infective endocarditis, ebstein anomaly).
Functional TR = secondary to RV dilation or pulm htn (ie right heart failure, pulm htn from lung diseases or left heart disease).

On physical exam, TR typically presents with a holosystolic murmur best heart at the left lower sternal border.
On POCUS, colour doppler is used to assess for the presence and severity of TR based on the regurgitant jet area in the RA, along with evaluation for RV heart dysfunction.

Steps for Image Acquisition:

Obtain A4C: Place the probe at the apex. Center the RV and RA with a straight septum. Visualize the tricuspid valve clearly.
Turn on Colour Doppler: Adjust the box to cover the RA and extend beyond the tricuspid valve leaflets.
Freeze Image: Capture the TR jet during systole. Freeze on the frame showing the largest jet.
Estimate TR Severity: Use the tracing tool to outline the regurgitant jet in the RA.
- The machine will calculate the jet area in cm²
- Consider the jet size and RA/RV dilation
  - Mild TR: < 5 cm²
  - Moderate TR: 5–10 cm²
  - Severe TR: > 10 cm²

The video shown has no features of tricuspid regurgitation.
Check out UBCs video of severe TR: https://www.ubcimpocus.com/new-gallery/2019/4/23/severe-tr-a4c-colour