Tricuspid regurgitation is generally caused by pulmonary hypertension, right ventricular enlargement, and tricuspid annular dilatation. Clinically, the manifestation of the etiology of tricuspid regurgitation is often noted, and the symptoms of right heart failure, such as weakness, ascites, edema, liver pain, dyspepsia, and poor nausea, are aggravated after the appearance of tricuspid regurgitation. The pathophysiology of tricuspid valve insufficiency is the result of tricuspid regurgitation, which is the return of systolic blood flow from the right ventricle into the right atrium, resulting in a highly enlarged right atrium with elevated pressure and impaired venous blood return. As a result of increased load on the right ventricle, compensatory and hypertrophic, right heart failure is likely to occur. Clinical manifestations Signs and symptoms of tricuspid valve insufficiency are related to the degree of valve closure insufficiency. Mild insufficiency is not easily detected clinically. In more severe cases, fatigue, poor appetite, liver distension, abdominal distention, and lower extremity edema may be present. Typical signs Jugular venous anger with pulsation; hepatomegaly with palpable pulsation; and a fully systolic blowing murmur at the 4th intercostal space at the left sternal border, which increases at the end of deep inspiration. Typical signs can be absent in patients with severe tricuspid regurgitation. If the liver is sclerotic due to prolonged blood depression, instead there is no longer a pulsation; the murmur no longer intensifies with inspiration after the right heart volume load has reached its extreme point, so the Carvallo sign can be negative. Radiographs show hypertrophy of the right atrium and right ventricle with a protrusion of the right edge of the heart, along with changes caused by other valvular lesions. The electrocardiogram shows atrial hypertrophy with high and wide P waves; there is also right bundle branch block or right ventricular hypertrophy, or even myocardial strain. Atrial fibrillation is often present. Echocardiography and Doppler examinations: cross-sectional ultrasound can detect the size of the tricuspid annulus and understand the thickening of the valve, which helps to distinguish relative and organic lesions. In tricuspid valve insufficiency, ultrasonography reveals microbubbles to and from the tricuspid valve; Doppler can directly monitor the abnormal signal from the right ventricle to the right atrium and can estimate the degree of regurgitation. Cardiac catheterization shows a prominent V wave of the right atrial pressure waveform with steepening of the y-descending branch, which is more pronounced during inspiration. The right atrial pressure waveform is similar to the right ventricular pressure waveform, only with smaller amplitude, which is called right ventricularized right atrial pressure and is a sign of severe tricuspid regurgitation. Cardiac angiography: right ventriculography and right anterior oblique cineography can show tricuspid regurgitation and its degree. However, there are potential false positives because the cardiac catheter crosses the tricuspid valve. The diagnosis of tricuspid valve insufficiency should include an understanding of the degree of insufficiency. Typical clinical signs are valuable in the diagnosis of severe tricuspid valve insufficiency. In the past, right ventriculography was used as a means to diagnose suspicious cases and to estimate the degree of regurgitation. In recent years, ultrasound and Doppler examinations have gradually replaced invasive examinations.