Tricuspid Regurgitation Stages A to D

What the result means

Stage A

At risk: no or trace regurgitation, with a leaflet abnormality or the substrate for a secondary leak - annular dilation, right-sided remodeling, an intracardiac lead.

Stage B

Progressive mild to moderate regurgitation.

Stage C

Asymptomatic severe: jet area 10 square cm or more, vena contracta 0.7 cm or more, orifice 0.40 square cm or more, or volume 45 mL or more.

Stage D

Severe with the signs of right heart failure: ascites, peripheral edema, raised venous pressure, fatigue.

Volume: 45, not 60

Severe here is 45 mL. On the mitral and aortic valves it is 60, so a left-sided figure carried across UNDER-calls a tricuspid leak.

Orifice: 0.40, not 0.30

Severe here is 0.40 square cm, the same as the mitral valve but not the aortic, where 0.30 is already severe. Carried across, that OVER-calls a tricuspid leak.

Hepatic vein reversal

Systolic flow reversal in the hepatic veins commonly accompanies severe regurgitation. Its absence alongside severe numbers is worth reconciling.

Usually secondary

The valve is normal and the ventricle, atrium or a lead has pulled it open. Unlike the mitral valve, that does NOT put it on separate severity criteria.

No C1 or C2

The tricuspid table does not subdivide asymptomatic severe disease on ventricular function the way the mitral and aortic tables do.