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Echocardiographic evaluation of the tricuspid valve

Nelson B Schiller, MD, FACC, FRCP, FASE
Bryan Ristow, MD, FACC, FASE, FACP
Xiushui Ren, MD
Section Editors
Warren J Manning, MD
William H Gaasch, MD
Deputy Editor
Susan B Yeon, MD, JD, FACC


Tricuspid valve disorders can be routinely identified and their severity can be estimated by echocardiography. From a technical standpoint, transthoracic echocardiography (TTE) of the tricuspid valve is slightly more challenging than it is for left-sided valves. The location of the tricuspid valve as the most rightward valve places it at or just beneath the sternal edge and requires the ultrasound beam to be angled sharply rightward while maintaining transducer contact with the chest wall. Image quality from the apical and subcostal windows is limited by far field beam attenuation and dispersion.

Despite these impediments, the tricuspid valve can be adequately evaluated in most TTE examinations.


Anatomically, the tricuspid valve consists of anterior, septal, and posterior leaflets. The anterior leaflet is the most anatomically constant echocardiographic feature, with the septal and posterior leaflets being variable in size and position.

Transthoracic echocardiogram — On two-dimensional (2-D) transthoracic echocardiography (TTE), the tricuspid valve is routinely recorded from the long (image 1) and short axis parasternal, apical four-chamber, and subcostal views. Overall, all tricuspid valve leaflets can be seen in less than 60 percent of patients with 2-D TTE from the subcostal window [1]. The normal tricuspid leaflet thickness is <3 mm [2].

Identification of individual tricuspid valve leaflets in the 2-D views has been controversial. Data from pathologic examination, rotational 2-D tomograms, and 2-D reconstructions from three-dimensional (3-D) images have facilitated correct leaflet identification in 2-D views [1,3-5]:

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Literature review current through: Nov 2017. | This topic last updated: Dec 22, 2016.
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