Echocardiographic assessment of the tricuspid and pulmonary valves

in Echo Research and Practice
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  • 1 A Zaidi, Cardiology, University Hospital of Wales, Cardiff, CF14 4XW, United Kingdom of Great Britain and Northern Ireland
  • 2 D Oxborough, Research Institute for Sports and Exercise Physiology, Liverpool John Moores University, Liverpool, L3 3AF, United Kingdom of Great Britain and Northern Ireland
  • 3 D Augustine, Cardiology, Royal United Hospital Bath, Bath, BA13NG, United Kingdom of Great Britain and Northern Ireland
  • 4 R Bedair, Cardiology, Bristol Heart Institute, Bristol Royal Infirmary, Bristol, United Kingdom of Great Britain and Northern Ireland
  • 5 A Harkness, Cardiology Department, East Suffolk and North Essex NHS Foundation Trust, Colchester, United Kingdom of Great Britain and Northern Ireland
  • 6 B Rana, Cardiovascular Medicine, Imperial College Healthcare NHS Trust, London, W2 1NY, United Kingdom of Great Britain and Northern Ireland
  • 7 S Robinson, Echocardiography, North West Anglia NHS Foundation Trust, Peterborough, PE3 9GZ, United Kingdom of Great Britain and Northern Ireland
  • 8 L Badano, Cardiology, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milan, Italy

Correspondence: Abbas Zaidi, Email:

Transthoracic echocardiography is the first-line imaging modality in the assessment of right-sided valve disease. The principle objectives of the echocardiographic study are to determine the aetiology, mechanism and severity of valvular dysfunction, as well as consequences on right heart remodelling and estimations of pulmonary artery pressure. Echocardiographic data must be integrated with symptoms, to inform optimal timing and technique of interventions. The most common tricuspid valve abnormality is regurgitation secondary to annular dilatation in the context of atrial fibrillation or left-sided heart disease. Significant pulmonary valve disease is most commonly seen in congenital heart abnormalities. The aetiology and mechanism of tricuspid and pulmonary valve disease can usually be identified by 2-dimensional assessment of leaflet morphology and motion. Colour flow and spectral Doppler are required for assessment of severity, which must integrate data from multiple imaging planes and modalities. Transoesophageal echo is used when transthoracic data is incomplete, although the anterior position of the right heart means that transthoracic imaging is often superior. Three-dimensional echocardiography is a pivotal tool for accurate quantification of right ventricular volumes and regurgitant lesion severity, anatomical characterisation of valve morphology and remodelling pattern, and procedural guidance for catheter-based interventions. Exercise echocardiography may be used to elucidate symptom status and demonstrate functional reserve. CMR and CT should be considered for complimentary data including right ventricular volume quantification, and precise cardiac and extracardiac anatomy. This BSE guideline aims to give practical advice on the standardised acquisition and interpretation of echocardiographic data relating to the pulmonary and tricuspid valves.

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    British Society of Echocardiography