[From anatomy to echocardiography in secondary tricuspid regurgitation. Controversial issues].

This review article describes two controversial aspects of secondary tricuspid regurgitation: the still poorly understood anatomy of the tricuspid valve and the advantages and limitations of color Doppler echocardiography in evaluating tricuspid regurgitation. The tricuspid apparatus is characterized by a complex anatomical structure that includes a saddle-shaped ring, three leaflets (or more), and a subvalvular apparatus. An in-depth knowledge of the anatomy is essential for understanding the various pathophysiological mechanisms of secondary (atriogenic and ventriculogenic) tricuspid regurgitation. Two-dimensional and three-dimensional echocardiography and color Doppler analysis play a key role in correct morphological and functional evaluation and in defining the etiology and extent of tricuspid regurgitation. A multiparametric approach that considers qualitative, semiquantitative, and quantitative parameters is recommended.