Tricuspid valve insufficiency, or tricuspid regurgitation, is a condition that involves a jet of blood pathologically leaking backward from the right ventricle into the right atrium during the systolic phase of the cardiac cycle.
Tricuspid valve insufficiency is widely classified into two categories: the primary type, which occurs due to congenital or acquired structural abnormalities of the tricuspid valve, and secondary tricuspid valve insufficiency, which is caused by other underlying heart pathologies, such as right ventricular dilatation, trauma, rheumatic heart disease, or infective endocarditis   .
Tricuspid valve insufficiency may be asymptomatic in patients with moderate, or even severe, stage of the disease. This can account for its frequent detection during diagnostic procedures carried out for other reasons, such as an assessment of left-side cardiac disease . When symptomatology is experienced by the patient, an appearance of the symptoms most commonly reported depend on whether or not tricuspid valve insufficiency is directly related to left ventricular dysfunction. These may generally include:
Diagnosing tricuspid valve insufficiency involves an extensive workup, including a consistent physical examination, laboratory tests, electrocardiography, echocardiography, and chest radiographs.
A thorough physical examination is the first step towards achieving diagnostic success. Common findings include distended jugular veins, hepatomegaly, pansystolic murmur auscultated in the parasternal area at the 4th intercostal space. Inspiration leads to a louder murmur and performing a Valsalva maneuver typically reduces its intensity. The physical examination may also reveal jaundice, peripheral edema, ascites, weak peripheral pulse, pulmonary rales, and an S3 or S4 gallop.
The imaging technique predominantly relied upon to diagnose tricuspid valve insufficiency is the transthoracic echocardiography (TTE), more specifically, the color flow Doppler echocardiography. This imaging modality allows for a comprehensive evaluation of the heart and can differentiate between primary and secondary tricuspid valve insufficiency . It can help to determine the severity of the condition and calculate annular diameters. Some of the echocardiographic criteria for the determination of a severe tricuspid valve insufficiency are :
Echocardiographic findings should always be interpreted in accordance with the phase of the respiratory cycle in which the image was taken. In tricuspid valve insufficiency inspiration augments the size of the right ventricle, alter its morphology, lead to tricuspid annular dilatation, and a deficit of the leaflet coaptation .
A transesophageal echocardiography is solely carried out in cases where the cause of tricuspid valve insufficiency cannot be pinpointed by a standard color flow transthoracic echocardiography .
Cardiovascular magnetic resonance (CMR) is another imaging modality that can be used to assess a potential tricuspid valve insufficiency and can aid in the calculation of the regurgitant fraction and volume .
Finally, laboratory tests may reveal hyperbilirubinemia and increased liver transaminase levels due to congestive hepatomegaly.