Tricuspid Regurgitation Assessment Using Cardiac Magnetic Resonance Velocity-Encoded 4-Dimensional Flow

Figure 1. Case 1 (A and B) Transthoracic echocardiography (TTE) showing incomplete tricuspid valve coaptation due to annular dilation on 2-dimensional TTE (A), with the tricuspid regurgitation (TR) jet on color Doppler (B). (C-E) Four-dimensional flow cardiovascular magnetic resonance (CMR) imaging of the TR jet (red) (C), the tricuspid and pulmonic valve flow curves (D), and right ventricular dilation on the short-axis cine imaging (E). TR volume with CMR was higher (120 mL) than the TTE estimate (52 mL).

Figure 2. Case 2 (A and B) Transthoracic echocardiography (TTE) showing severe tricuspid regurgitation (TR) on Doppler echocardiography (A), with tricuspid annular dilation and a moderately enlarged right ventricular chamber (B). (C-E) Cardiovascular magnetic resonance imaging demonstrating a severe TR jet concordant with TTE (50 mL in both; red) (C), tricuspid and pulmonic valve flow curves (D), and right ventricular dilation on the short-axis cine imaging (E). PA = pulmonary artery; RA = right atrium; RV = right ventricle.

Figure 3. Case 3 (A and B) Transthoracic echocardiography (TTE) showing severe tricuspid regurgitation (TR) on Doppler echocardiography (A), with tricuspid annular dilation and moderate right ventricular enlargement (B). (C-E) Cardiovascular magnetic resonance (CMR) imaging with a mild to moderate TR jet (eccentric red jet; black arrow) (C), tricuspid and pulmonic valves flow curves (D), and normal right ventricular chamber size on the short-axis cine imaging (E). TR volume with CMR was significantly lower (15 mL) than the TTE estimate (48 mL).