Preliminary experience with reversal of venoatrial flow in the diagnosis of tricuspid regurgitation

Present methods of assessing tricuspid regurgitation are often unreliable. We present preliminary data concerning a new angiographic method for identification of tricuspid regurgitation which evaluates direction of flow of contrast media during right ventricular (RV) systole in the inferior vena cava (IVC) and hepatic veins following right atrial or IVC angiography. Group I consisted of 15 patients who had tricuspid regurgitation by conventional criteria. All 15 patients exhibited reversal of venoatrial flow by right atrial or inferior vena cava angiography. In a control group (group III) of 20 patients who do not have clinical tricuspid regurgitation, one patient demonstrated retrograde flow. Group II consisted of 11 patients with mitral valve disease and mild to moderate pulmonary hypertension. All 11 had no conventional evidence of tricuspid regurgitation; however, all 11 had the pathophysiologic potential for tricuspid regurgitation. Five of 11 had reversal of venoatrial flow during RV systole, suggesting the presence of clinically inapparent tricuspid. In conclusion, preliminary data suggest that angiographic reversal of venoatrial flow may be both sensitive and specific for the presence of tricuspid regurgitation. Further investigation with comparison to RV angiography and real-time echocardiography should be performed.