Tricuspid regurgitation (TR) (also known as tricuspid insufficiency) is a common finding in imaging of the fetus. Tricuspid regurgitation represents the abnormal backflow of blood into the right atrium during right ventricular contraction due to valvular leakage (i.e. it is a valvulopathy).
Tricuspid regurgitation is a common sonographic finding during fetal life and can be seen in 7% of normal fetuses 1.
Trivial tricuspid regurgitation can be an isolated finding in an otherwise normal fetus with no other structural abnormality 2. It may be associated with aneuploidy and with both cardiac and extracardiac defects 3-5.
Technique: the pulsed Doppler gate should be placed perpendicular across the tricuspid valve in the four-chamber view with the angel of insonation <20°.
Diagnosis is made when the regurgitation jet velocity is at least 80 cm/sec and its interval extends to more than half of systole 7. Color Doppler shows flow in the opposite direction with a different color compared to mitral valve flow with aliasing, denoting high-velocity flow in opposite direction.
Trivial tricuspid regurgitation
- prevalence: 1-5%
- isolated finding
- resolution with follow-up
Mild tricuspid regurgitation
- mid or early systolic
- peak velocity: 30-70 cm/s
- jet extends <1/3 distance to the opposite atrial wall 6
Severe tricuspid regurgitation
- peak velocity: 180-350 cm/s
- 1. Wiechec M, Nocun A, Wiercinska E, Beithon J, Knafel A. First trimester tricuspid regurgitation and fetal abnormalities. (2015) Journal of perinatal medicine. 43 (5): 597-603. doi:10.1515/jpm-2014-0058 - Pubmed
- 2. Respondek ML, Kammermeier M, Ludomirsky A, Weil SR, Huhta JC. The prevalence and clinical significance of fetal tricuspid valve regurgitation with normal heart anatomy. (1994) American journal of obstetrics and gynecology. 171 (5): 1265-70. doi:10.1016/0002-9378(94)90144-9 - Pubmed
- 3. Faiola S, Tsoi E, Huggon IC, Allan LD, Nicolaides KH. Likelihood ratio for trisomy 21 in fetuses with tricuspid regurgitation at the 11 to 13 + 6-week scan. (2005) Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. 26 (1): 22-7. doi:10.1002/uog.1922 - Pubmed
- 4. DeVore GR. Trisomy 21: 91% detection rate using second-trimester ultrasound markers. (2000) Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. 16 (2): 133-41. doi:10.1046/j.1469-0705.2000.00203.x - Pubmed
- 5. Gembruch U, Smrcek JM. The prevalence and clinical significance of tricuspid valve regurgitation in normally grown fetuses and those with intrauterine growth retardation. (1997) Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. 9 (6): 374-82. doi:10.1046/j.1469-0705.1997.09060374.x - Pubmed
- 6. Messing B, Porat S, Imbar T, Valsky DV, Anteby EY, Yagel S. Mild tricuspid regurgitation: a benign fetal finding at various stages of pregnancy. (2005) Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. 26 (6): 606-9; discussion 610. doi:10.1002/uog.1999 - Pubmed
- 7. K. O. Kagan, C. Valencia, P. Livanos et-al. Tricuspid regurgitation in screening for trisomies 21, 18 and 13 and Turner syndrome at 11 + 0 to 13 + 6 weeks of gestation. (2009) Ultrasound in Obstetrics and Gynecology. 33 (1): 18. doi:10.1002/uog.6264 - Pubmed