Five-Grade Classification of Tricuspid Regurgitation: Massive and Torrential Degrees
In the provided source fragments, explicit numerical criteria distinguishing the massive and torrential categories within the five-grade classification of tricuspid regurgitation (TR) are absent. Corresponding thresholds [to be clarified] cannot be presented based on available materials without risk of introducing unverified data.
Parameters of Quantitative TR Assessment Based on Available Data
According to recommendations for standardization of echocardiographic reports (C.C. Taub, R.F. Stainback et al., 2025), the following indicators are documented for TR assessment:
| Parameter | Designation | Units |
|---|---|---|
| Peak TR velocity | TRmax Vel | m/s |
| Peak TR pressure gradient | TRmax PG | mmHg |
| TR PISA radius | TR PISA r | cm |
| PISA aliasing velocity | TR PISA aliasing vel | cm/s |
| Effective regurgitant orifice area (PISA) | TR PISA EROA | cm² |
| 3D EROA | 3D TR EROA | cm² |
| TR vena contracta | TR VC | cm |
| 3D vena contracta area | 3D TR VCA | cm² |
Criterion of Severe TR Based on Available Fragments
According to Manual of Echocardiography for Congenital Heart Diseases (2024), vena contracta width >0.7 cm indicates severe TR. Multiple regurgitant jets may complicate severity assessment. In Ebstein anomaly, TR is typically low-pressure TR, which is important to consider during interpretation.
Normative Values of Tricuspid Valve Flow
The upper limit of normal TRVmax is <2.5 m/s (B.V. Blagodir, 2024). TRVmax is used to calculate right ventricular systolic pressure (RVSP) accounting for right atrial pressure; in the absence of RVOT obstruction, RVSP corresponds to systolic pulmonary artery pressure (RVSP=SPAP).
Conclusion: for accurate presentation of the five-grade classification with massive and torrential categories, additional sources with specific threshold values for EROA, regurgitant volume, vena contracta width and area are required [to be clarified].
Frequently asked questions
What vena contracta threshold indicates severe TR?
According to Manual of Echocardiography for Congenital Heart Diseases (2024), vena contracta width >0.7 cm indicates severe TR.
Which quantitative parameters are documented for TR?
TRmax Vel, TRmax PG, PISA radius and aliasing velocity, EROA (PISA and 3D), vena contracta (linear and 3D area) — according to reporting standardization recommendations (2025).
Are there thresholds for massive and torrential in the fragments?
No. Numerical criteria for massive and torrential categories are absent in the provided fragments [to be clarified].
What is the upper limit of normal TRVmax?
The upper limit of normal TRVmax is <2.5 m/s (B.V. Blagodir, 2024); the indicator is used to calculate RVSP/SPAP.
What is characteristic of TR in Ebstein anomaly?
TR in Ebstein anomaly is typically low-pressure TR, and multiple jets may complicate severity assessment.