Figure 4.

Examples of modern day aetiologies responsible for tricuspid regurgitation. Four-chamber view showing RV pacing lead with echo bright regions (likely reflecting fibrosis) and tethering of the lead to the septal TV leaflet, which resulted in severe regurgitation. (A) 3D imaging is an important adjunct in providing details of the underlying abnormalities and leaflet involvement; en face views from the RV surface and multiplane reconstruction formats are particularly useful in this regard. (B) TV posterior leaflet prolapse and flail segment resulting from a sheering injury with severe regurgitation. (C) 3D zoom mode echo image of tricuspid valve viewed from the RV surface, demonstrating loss of coaptation in the central portion of the valve (*). This has resulted from TV annular dilatation as a consequence of RV dilatation in the setting of pulmonary hypertension. There is massive tricuspid regurgitation in, S septal, P posterior and A, anterior leaflets. (D) 3D zoom mode surgical view of the mitral valve depicting severe mitral stenosis (* denotes mitral valve orifice), a typical left heart valve lesion that may result in post capillary pulmonary hypertension and functional tricuspid regurgitation. AV aortic valve; LAA, left atrial appendage; RA, right atrium; RV, right ventricle.