Table 42. Step 1: Diagnosis of severe tricuspid regurgitation¹⁴⁹.

	Characteristics of severe tricuspid regurgitation
Physical examination	Pathological jugular venous stasis Hyperphonetic second heart sound (pulmonary arterial hypertension) Regurgitative systolic murmur in the left sternal border associated with Rivero-Carvallo sign Hepatomegaly
Electrocardiogram	Right chamber overload AF
Chest radiography	Signs of enlarged right chambers Pulmonary congestion, only when associated with left side valvular disease Enlargement pulmonary trunk
Echocardiogram	EROA ≥ 0.40 cm² Reverse flow in hepatic veins Regurgitant volume > 45 ml/beat Dense, triangular regurgitant volume, with early peak on continuous Doppler. Vena contracta ≥ 0.7 cm Annulus diameter ≥ 40 mm Failed cusp coaptation
Hemodynamic study	Case of clinical and echocardiographic discordance Measures SPAP in cases with failed cusp coaptation
Magnetic resonance	Case of clinical and echocardiographic discordance or limited quality of echocardiographic image

AF: atrial fibrillation; EROA: effective regurgitant orifice area; SPAP: systolic pulmonary artery pressure.