Superiority of 10% air-10% blood-saline mixture for measuring the velocity of tricuspid regurgitation in patients with severe emphysema.

BACKGROUND: Severe emphysema frequently is associated with elevated pulmonary artery systolic pressure. However, it is often difficult to obtain adequate tricuspid regurgitation (TR) signals for measurement of pulmonary artery systolic pressure in patients with severe emphysema. PURPOSE: This study was conducted to evaluate the usefulness of air-blood-saline mixture in measuring TR velocity in severe emphysema. METHODS: We studied 82 patients with severe emphysema (67.7 +/- 9.2 years, 57 males) who had no or mild TR on color Doppler. Contrast echocardiography studies were performed with agitated 10% air-90% saline and 10% air-10% blood-80% saline mixtures. Tracing quality and peak velocity were assessed on baseline continuous wave signals and contrast continuous wave signals with the 2 mixtures. RESULTS: With the injection of an air-saline mixture, the quality of TR tracing improved in 45 patients (P <.0001) and a higher peak TR velocity was obtained (2.46 +/- 0.37 m/s vs 2.95 +/- 0.40 m/s, P <.0001) compared with baseline echocardiography. Compared with air-saline mixture, the air-blood-saline mixture further enhanced TR tracing quality in 17 patients (P <.0001) and the peak TR velocity increased to 3.13 +/- 0.42 m/s (P <.0001). CONCLUSIONS: In patients with severe emphysema, an air-blood-saline mixture improves the quantifiable TR signals for more accurate estimation of pulmonary artery systolic pressure, even when there is minimal valve TR.     

Pulsed Doppler echocardiography in the assessment of tricuspid regurgitation

Pulsed Doppler echocardiography is a noninvasive method with high sensitivity and specificity for the assessment of tricuspid regurgitation. In patients with tricuspid regurgitation, pansystolic unusual Doppler signals are detected in the right atrial cavity, which are interpreted as tricuspid regurgitant flow signals. They distributed in a spindle-shaped area from the tricuspid orifice toward the right atrial posterior wall in parallel with the interatrial septum. The orientation of the range where the regurgitant Doppler signals are detected in the right atrial cavity shows the direction of the regurgitant jet. However, such a result is determined mainly in patients with functional tricuspid regurgitation. In regard to patients with organic tricuspid lesion, different considerations may be necessary. Semiquantitative grading of the severity of regurgitation is possible, based on the distance covered by the regurgitant signals from the tricuspid orifice. Tricuspid regurgitation is demonstrated also by contrast echocardiography. The severity is graded based on the distance reached by regurgitant curvilinear contrast echoes from the tricuspid valve in the M-mode echocardiography. If the ultrasound beam is adequately directed through the tricuspid orifice, the grade estimated by the contrast echoes are well correlated with that by the Doppler. However, if the M-mode is performed without the guide by the two-dimensional image, it may miss the most adequate beam direction for the observation, resulting in underestimating severity. The influences of tricuspid regurgitation are generally seen in the flow pattern of the major veins. However, they are more sharply reflected by the flow condition in the right atrial cavity than by the flows patterns in the major veins.     

Usefulness of the mitral/aortic flow velocity integral ratio as a screening method to identify patients with hemodynamically significant mitral regurgitation.

OBJECTIVE: We sought to test the value of a simple Doppler index, the mitral/aortic flow velocity integral ratio (MAVIR), as a screening method to identify patients with hemodynamically significant mitral regurgitation (MR). METHODS: Included in the study were 91 patients (mean age 61 +/- 14 years; 54% men) with echocardiographically diagnosed MR. The cause was organic in 23 patients and ischemic/functional in 68. MR degree was assessed by 2 quantitative echocardiographic measures: the regurgitant fraction and the regurgitant orifice area. RESULTS: A good correlation was found between MAVIR and both regurgitant fraction (r = 0.75) and orifice (r = 0.60). When we divided patients into 3 groups on the basis of the regurgitant fraction, used as reference standard, MAVIR significantly increased in proportion to MR severity (0.7 +/- 0.1 for mild MR vs 1.1 +/- 0.2 for moderate and 1.4 +/- 0.3 for severe regurgitation; P <.0001). A ratio > 1 identified 28 of 30 patients with severe MR (regurgitant fraction > 60%), whereas all patients with mild MR (regurgitant fraction < 40%) had a ratio < 1. Using a regurgitant orifice >or= 40 mm(2) as threshold for severe MR, a significant difference in MAVIR was also present among patients who had severe MR compared with those having mild and moderate regurgitation (P <.0001). CONCLUSIONS: These findings suggest that MAVIR is a sensitive index, potentially widely applicable in clinical practice as a screening parameter for identifying patients with hemodynamically significant MR.     

Frequency of Doppler measurable pulmonary artery pressures

The current literature suggests that right-sided heart pressures can be obtained noninvasively in approximately 60% of patients. We hypothesized that with a focused echocardiographic Doppler examination, measurable tricuspid or pulmonary valve regurgitation suitable for measuring pressures could be obtained in a higher percentage of patients. The study group consisted of 200 consecutive patients undergoing echocardiographic and Doppler hemodynamic evaluation. All patients were first examined by an ultrasonographer instructed to attempt to record tricuspid and pulmonary regurgitant velocities. After this examination, a designated cardiologist performed a focused examination with the intent of improving the signal quality and increasing the number of measurable signals for evaluation. Tricuspid regurgitation of measurable quality was recorded in 147 (73.5%) of 200 patients by the ultrasonographer; this result was improved to 172 patients (86%) by the designated cardiologist. Pulmonary regurgitation was obtainable in 147 (95%) of 154 patients and was of measurable quality in 137 (89%). When results of tricuspid and pulmonary regurgitation were combined, a quantifiable signal was obtained in 194 (97%) of 200 consecutive unselected patients. This study demonstrates that a well-trained ultrasonographer or echocardiologist can obtain right-sided pressures in at least 95% of all unselected cardiovascular patients.     

Doppler-determined peak systolic tricuspid pressure gradient in persons with normal pulmonary function and tricuspid regurgitation.

The Doppler-estimated peak systolic tricuspid pressure gradient is the most reliable noninvasive method for the evaluation of pulmonary artery systolic pressure in patients with tricuspid regurgitation. Our goal was to evaluate the range of this gradient in healthy persons and determine a normal upper limit. We studied 53 healthy persons (34 women, 19 men; aged 14 to 55 years, mean 38.9 +/- 12.7 years) who did not smoke and who had an adequate Doppler signal of tricuspid regurgitation. The presence of pulmonary or cardiac disorders was excluded by a review of the subject's medical history in addition to physical examination, spirometry, arterial blood gasses determination, electrocardiography, chest x-ray examination, and rest echocardiography. Tricuspid gradient ranged from 12.6 to 29. 3 mm Hg (mean 19.3 +/- 4.0); 35.8% of patients had values higher than 20 mm Hg. In conclusion, a tricuspid gradient of 30 mm Hg may be considered as the upper normal limit. The different approaches for estimating mean right atrial pressure are also discussed.     

Right-to-left shunt through a patent foramen ovale caused by severe tricuspid regurgitation detected with color Doppler echocardiography.

We describe a 65-year-old patient with moderate combined mitral disease and severe tricuspid regurgitation, in whom the tricuspid regurgitant jet was oriented toward the interatrial septum. Color flow and pulsed Doppler demonstrated a late-systolic to mid-diastolic, right-to-left shunting of the tricuspid regurgitant jet through the foramen ovale. This finding was subsequently confirmed with transesophageal echocardiography.     

Severity of mitral and aortic regurgitation as assessed by cardiovascular magnetic resonance: optimizing correlation with Doppler echocardiography.

BACKGROUND: Cardiovascular magnetic resonance (CMR) is widely recognized as a non-invasive gold standard for quantification of ventricular volumes. In addition, it is an emerging diagnostic modality for clinical evaluation of mitral regurgitation (MR) and aortic regurgitation (AR). CMR facilitates accurate quantitation of regurgitation volumes and regurgitant fraction, but referring physicians are often more comfortable with qualitative measures, and few data exist for correlation of qualitative CMR regurgitation severity with that obtained by more conventional qualitative Doppler echocardiography. Because patients with AR and MR may commonly be assessed by both echocardiography and CMR modalities, consistency between qualitative gradient of regurgitation severity is important for follow-up. Therefore, we sought to define the CMR regurgitant fractions that best correlate with qualitative mild, moderate, and severe regurgitation by color Doppler echocardiography. METHODS AND RESULTS: Data from 141 consecutive patients (age 53 +/- 15 yr; 43% female) with contemporary (median, 31 days) CMR and echocardiographic data, including 107 regurgitant valves and 70 normal valves, were compared. Thresholds were developed on an initial cohort of patients with 55 regurgitant valves, and subsequently tested on a later cohort of patients with 52 regurgitant valves. Regurgitation fraction (RF) limits that optimized concordance of CMR and echo severity grades were similar for MR and AR and were: mild < or = 15%, moderate 16-25%, moderate-severe 26-48%, severe > 48%. CONCLUSIONS: The current study provides simple qualititative threshold grades for MR and AR severity that allows for standardized reporting of regurgitation severity by CMR and excellent correlation with clinical echocardiography.     

以立体角代替平面角彩色多普勒血流会聚法评估三尖瓣返流程度

目的　探讨彩色多普勒血流会聚法在评估三尖瓣返流程度中的应用价值。方法　应用不同的血流会聚方程对３２例三尖瓣返流患者的返流程度进行测量, 并与传统法所测指标进行比较。结果　应用立体角会聚方程计算的返流率（Ｆ２）与传统方法测得的返流束指标ＳＲ／ＳＲＡ、ＶＰ 以及二维多普勒方法计算的每搏返流量Ｑ之间的相关关系（ｒ分别为０．４８, ０．４６, ０．９８）优于应用平面角会聚方程计算的返流率（Ｆ１）, 与上述指标之间的相关关系（ｒ分别为０．４６, ０．４４, ０．９２）。而且ＳＶ１明显低估返流程度,ＳＶ２更接近于实际值。结论　应用立体角会聚方程代替平面角会聚方程能更为准确地评估三尖瓣返流程度     

胸压对三尖瓣反流速度和肺动脉压测定的影响

目的 应用超声心动图观察平静呼吸情况下胸压对三尖瓣反流速度的影响及规律,为超声心动图准确测定肺动脉压和验证呼吸影响心功能机制新假说提供依据.方法 对50例三尖瓣反流患者,利用二维及多普勒超声心动图记录不同呼吸时相三尖瓣反流速度和跨瓣压,观察不同呼吸时相时三尖瓣反流速度的变化规律.结果 呼吸对三尖瓣反流速度有确定影响,反流速度与呼吸时相关系表现有三种类型:第一种为吸气相速度增加,呼气相速度减小;第二种表现与第一种相反;第三种为速度变化表现为随机性.结论 呼吸性胸压变化对三尖瓣反流速度有明确影响,提示用多普勒法无创测定肺动脉压时需要将呼吸停止在呼吸时相的中期,并保持测定过程中胸压稳定,以提高测定准确性.     

Quantitative assessment of valvular regurgitations using the pulsed Doppler technique. Approach to the regurgitant lesion

It is now possible with pulsed Doppler to grade the severity of aortic, mitral and tricuspid regurgitations on a quantitative basis. “Indices” were devised, using the measurement of the spatial extent of abnormal Doppler signals.For aortic regurgitation: (1) at the aortic valvular orifice area, by measurement of the regurgitant aortic valvular area and calculation of the valvular regurgitant “index”. (2) In the left ventricle outflow tract, by calculation of an “index” combining information from two echographic (short and long axis) planes.For mitral regurgitation: by calculation of the total regurgitant “index” combining information from examination of the annulus in short axis, and of the left atrium in long axis view.For tricuspid regurgitation: at the tricuspid annulus, by averaging the depth of the reversal wave on two samples recorded using various echographic approaches.A group of patients with aortic (42), mitral (55) and tricuspid (57) regurgitation proven by invasive procedures, was investigated with this procedure using a 3 MHz two dimensional pulsed Doppler echo device. Correlative coefficients between the Doppler grading and that provided by independently performed invasive procedures on a three point scale, ranged between 0.66 and 0.88, with significant differentiation of mean values of indices (P < 0.01 to P < 0.001) for each grade of severity.Success in the Doppler grading of severity of the regurgitations requires (1) a sampling as close as possible to the lesion, and optimally at the very site of the lesion, (2) the largest explorable area at the site of the lesion, (3) the relevancy of the selected Doppler parameter in order to take into account, as much as possible, the three dimensional configuration of the regurgitant jet. Moreover, this mapping procedure provides a pathophysiological insight of the regurgitant lesion for left-sided regurgitations.     

Continuous recording of pulmonary artery diastolic pressure and cardiac output using a novel ultrasound transducer.

BACKGROUND: The feasibility of hands-free transthoracic continuous determination of pulmonary artery (PA) diastolic pressure (PAD) and cardiac output (CO) by Doppler ultrasound has not been previously demonstrated. We developed a 2.5-MHz spherical transducer mounted in an external housing to permit steering in 360 degrees (Contison). The external housing was attached to the chest wall using an adhesive patch. Methods and Results: Fifty patients in the coronary care department who had PA catheters had Doppler ultrasound studies. The 2.5-MHz spherical transducer was placed at the left sternal border to permit imaging of the pulmonic valve and was attached to a commercial ultrasound machine. The PA was imaged and its diameter measured. The pulmonary flow velocity signal was recorded and the time velocity integral obtained. The CO was calculated as: CO = time velocity integral of the PA systolic flow velocity signal x pi diameter(2) divided by 4 x heart rate. The pulmonary regurgitation signal was then recorded and the end-diastolic velocity of the regurgitant signal was measured. Right atrial pressure was assessed from the jugular venous pressure or from the size and pulsatility of the inferior vena cava. The PADP was calculated as: PADP = 4 end-diastolic velocity of the regurgitant signal(2) + right atrial pressure. The CO, PADP, and pulmonary wedge pressure were recorded from the PA catheter immediately after the ultrasound studies. Serial data were obtained every half hour or 1 hour up to a maximum of 5 hours. Adequate Doppler signals were obtained in 43 patients. RESULTS: There was a good correlation between the PADP by Doppler versus PA catheter (r = 0.90, standard error of the estimate = 3.3 mm Hg); PADP by Doppler versus PA wedge pressure (r = 0.88, standard error of the estimate = 3.7 mm Hg); and CO by Doppler versus PA catheter (r = 0.92, standard error of the estimate = 0.7 L/min). CONCLUSION: The 2.5-MHz spherical transducer permitted accurate assessment of CO and PAD. This transducer could be of potential value in monitoring patients in the intensive care setting.     

近场射流宽度在评价三尖瓣返流中的应用探讨

本文观察了39例三尖瓣返流患者的彩色返流束，根据返流束是否偏心分为中心返流组（A组）和偏心返流组（B组），并把两组返流束大小参数同多普勒法计算的每搏返流流率进行相关分析。结果发现，近场射流宽度与三尖瓣返流流率间在A、B两组均呈良好相关（r＝0.75，和0.71，P＜0.05），返流束长度及面积在A组与运流流率间呈中度相关（r＝0.58，和0.54，P＜0.05），而在B组则无明显相关（P＞0.05）。结论：（1）近场射流宽度可以较准确地评价三尖瓣返流程度;（2）在偏心三尖瓣返流时彩色返流束长度和面积低估返流程度。     

Noninvasive assessment of left ventricular isovolumic contraction and relaxation with continuous wave Doppler aortic regurgitant velocity signals: an in vivo validation study.

The purpose of this study was to provide fundamental in vivo validation of a method with the use of aortic regurgitant (AR) jet signals recorded with continuous wave (CW) Doppler for assessing left ventricular (LV) isovolumic contraction and relaxation. Preliminary studies have suggested that analysis of CW Doppler AR velocity signals permits the estimation of LV positive and negative dP/dt. We studied 19 hemodynamically different states in 6 sheep with surgically induced chronic aortic regurgitation. CW AR velocity spectra and high-fidelity LV and aortic pressures were recorded simultaneously. Rates of LV pressure rise and fall (RPR and RPF) were calculated by determining the time interval between points at 1 m/s and 2.5 m/s in the deceleration and acceleration slopes of the CW Doppler AR velocity envelope (corresponding to a pressure change of 21 mm Hg). RPR and RPF calculated by CW Doppler analysis for each state were compared with the peak positive dP/dt and negative dP/dt, obtained from the corresponding high-fidelity LV pressure curve, respectively. The LV peak positive and negative dP/dt derived by catheter ranged from 817 to 2625 mm Hg/s and from 917 to 2583 mm Hg/s, respectively. Multiple regression analysis showed that Doppler RPR correlated well with catheter peak positive dP/dt (r = 0.93; mean differences, -413 +/- 250 mm Hg/s). There was also good correlation and agreement between Doppler RPF and the catheter peak negative dP/dt (r = 0.89; mean difference, -279 +/- 239 mm Hg/s). Both Doppler-determined RPR and RPF underestimated their respective LV peak dP/dt. CW Doppler AR spectra can provide a reliable noninvasive estimate of LV dP/dt and could be helpful in the serial assessment of ventricular function in patients with aortic regurgitation.     

Echocardiography for evaluating anatomic repair of transposition of the great arteries.

Fifteen survivors of a single-stage anatomic correction of complete transposition of the great arteries performed at a mean age of 1 month were studied by cross-sectional echocardiography, conventional Doppler echocardiography, Doppler color flow mapping, and catheterization at mean of 10 months after surgery. Small aortic regurgitant jets were documented by angiography and Doppler color flow mapping in seven patients. A trivial supravalvular pulmonary gradient was present in seven patients and a mild to moderate gradient in three. Pulmonary artery flow velocities correlated well with those measured at cardiac catheterization (r = 0.96, standard error of the estimate = 2.6 mm Hg). The present study suggests that combined cross-sectional echocardiography, conventional Doppler echocardiography, and Doppler color flow mapping can be used in the follow-up of patients who have had anatomic repair of transposition of the great arteries, reducing the need for repeated postoperative cardiac catheterizations.     

二尖瓣狭窄患者的下腔静脉口脉冲多普勒超声心动图观察

目的探讨二尖瓣狭窄（二狭）患者下腔静脉回流入右房状态。方法用彩色多普勒超声心动图对７４例二狭患者及３２例对照者沿胸骨右缘纵切探查下腔静脉口的最大内径及血流速度。结果对照组、二狭并轻度三尖瓣返流者（Ⅰ组）、二狭并中度三尖瓣返流者（Ⅱ组）及二狭并重度三尖瓣返流者（Ⅲ组）四组的下腔静脉口内径有显著差异（分别为２０．１±２．４ｍｍ、１７．０±５．９ｍｍ、１６．１±６．２ｍｍ及２７．８±１０．２ｍｍ）。但四组的下腔静脉口峰值血流速度及平均血流速度无明显的差别。简单线性相关分析发现二狭非重度三尖瓣返流者（Ⅰ组、Ⅱ组）的下腔静脉口内径与其峰值血流速度之间呈明显的负相关关系（ｒ＝－０．６２，Ｐ＜０．０１），且下腔静脉口内径与左房内径亦呈明显负相关关系（ｒ＝－０．７１，Ｐ＜０．０１）。结论二狭患者增大的左房可引起下腔静脉口的静脉回流减少     

Color flow Doppler mapping studies of "physiologic" pulmonary and tricuspid regurgitation: evidence for true regurgitation as opposed to a valve closing volume.

Color flow Doppler mapping using either an Aloka 880 or a Toshiba SSH65A system was performed in 39 normal subjects (aged 13 to 45 years) and 43 patients (aged 13 to 82 years) with pathologic tricuspid or pulmonary regurgitation to evaluate the incidence of "physiologic" regurgitation of right heart valves and to determine the differentiating characteristics in the spatial distribution and velocity encoding of "normal" and "pathologic" regurgitant jets. In the normal subjects, tricuspid and pulmonary regurgitation were documented in 32 (83%) and 36 (93%), respectively, and were unrelated to the system being used. Flow acceleration and aliasing were imaged on the right ventricular side of the tricuspid regurgitant orifice and on the pulmonary artery side of the pulmonary valve (in both normal subjects and patients), and indicated flow convergence for true regurgitation through an orifice as opposed to blood being driven retrogradely by the closing valve. Such proximal acceleration was documented in all patients with pathologic tricuspid regurgitation, in 31/32 of the normal subjects with tricuspid regurgitation, and was also observed in 12/15 (80%) of the patients and 4/12 (33%) of normal subjects with pulmonary regurgitation who were examined with the Toshiba system. The dimensions (mean +/- SD) of tricuspid regurgitant jets (length [JL] and area [JA]) were consistently larger in the patients than in the normal subjects [JL: 3.4 +/- 0.9 vs 1.2 +/- 0.5 cm, p less than 0.001; and JA: 5.7 +/- 2.0 vs 1.4 +/- 0.7 cm2, p less than 0.001) as were the pulmonary regurgitation jet dimensions (JL: 1.8 +/- 0.4 vs 0.9 +/- 0.08 cm, p less than 0.001; JA: 1.8 +/- 0.7 vs 0.3 +/- 0.08 cm2, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)     

Evaluation of valvular regurgitation severity using digital acquisition of echocardiographic images.

BACKGROUND: Digital acquisition is a technique for storing echocardiographic data that offers advantages over conventional videotape (VT); however, limited information is available on its accuracy for the evaluation of valvular regurgitation. METHODS: We evaluated 102 patients with at least 1 regurgitant lesion. Data were obtained on VT and in 1 cardiac cycle stored digitally (1C). To assess for incremental improvement with acquisition of multiple cycles, digital images were also acquired with 2 (2C) or 3 cardiac cycles (3C). Both digital and VT images were graded for regurgitant severity as absent, trivial, mild, moderate, or severe. Kappa statistics were used to assess agreement. RESULTS: A total of 171 valvular regurgitant lesions (mild or greater) were evaluated. The overall agreement between 1C and VT images was kappa = 0.61. With multiple cycle acquisition, there was no improvement in agreement (kappa = 0.56 and 0.57 for 2C and 3C, respectively). When subgrouped, the level of agreement between 1C and VT was slightly lower for the aortic valve than for the mitral or tricuspid valves (kappa = 0.49, 0.63, 0.64, respectively). CONCLUSION: The 1C technique has substantial agreement and correlation with standard VT for the evaluation of regurgitant lesions with the use of color flow Doppler. The acquisition of multiple cardiac cycles does not provide incremental improvement over single beat acquisition.     

实时三维彩色多普勒血流显像与磁共振定量心脏瓣膜反流束容积的对照研究

目的探讨实时三维彩色多普勒血流显像（RT-3DCDFI）技术诊断和定量评估心脏瓣膜反流的临床应用价值。方法17例主动脉瓣反流患者和11例二尖瓣反流患者,应用RT-3DCDFI采集瓣膜反流束三维彩色多普勒血流信号数据库,导入TomTec三维图像工作站脱机测量反流束容积,并与磁共振（MRI）测值对照。结果28例瓣膜反流RT-3DCDFI检查均取得满意效果,包括中心型反流19例（主动脉瓣反流12例,二尖瓣反流7例）,偏心型反流9例（主动脉瓣反流5例,二尖瓣反流4例）。RT-3DCDFI与MRI对反流束容积的测值相关性良好。全部病例组RT-3DCDFI与MRI测值相关性r=0.93,Y=0.89X＋3.39,P〈0.0001,二者间的均数差为1.7ml,标准差为8.3ml;中心型反流组RT-3DCDFI与MRI测值相关性r=0.94;偏心型反流组RT-3DCDFI与MRI测值相关性r=0.91。结论RT-3DCDFI可准确测量瓣膜反流束容积,有望为临床定量评估心脏瓣膜反流提供一种简便、准确、可靠的新方法。     

彩色多普勒血流会聚法定量评估二尖瓣返流严重程度的研究

彩色多普勒血流会聚区（ＦＣＲ）法是近几年发展起来的一定量二尖瓣返流的新方法。本文应用该方法，对５５例显示血流会聚区的二尖瓣返流患者行ＦＣＲ法与返流束面积法（ＳＲ）、返流束面积与左房面积之比法（ＳＲ／ＳＬＡ）相比较，相关系数分别为０．８２２及０．７３２（Ｐ值均小于０．０１），并应用ＦＣＲ法定量测定二尖瓣返流率。按不同的返流率将二尖瓣返流分为轻、中、重三度。本文认为血流会聚法为定量评估二尖瓣返流（特别是中至重度返流）一较为理想的无创性方法，具有广泛的理论研究及临床应用前景。     

Tricuspid regurgitation in children: a pulsed Doppler, contrast echocardiographic and angiographic comparison

Thirty-one children with congenital heart disease were examined for tricuspid regurgitation by four methods: (1) auscultation, (2) pulsed Doppler echocardiography, (3) saline contrast echocardiography, and (4) right ventricular angiography. Tricuspid regurgitation was detected in three children by auscultation, in 20 by pulsed Doppler echocardiography, in 21 by saline contrast echocardiography, and in 20 by right ventricular angiography. To determine the prevalence of tricuspid regurgitation in children suspected of having congenital heart disease, we reviewed 5417 Doppler echocardiograms performed between 1983 and 1985. Tricuspid regurgitation was detected in 399 of 4670 children (8.5%) with congenital heart disease and in 26 of 106 newborns (25%) with respiratory distress. By comparison, tricuspid regurgitation was detected in only 19 of 641 (3%) normal children. Tricuspid regurgitation is uncommon in normal children, but its incidence in children with congenital heart disease and/or respiratory distress is high.