Tricuspid Valve Prolapse: Echocardiographic Assessment

Tricuspid valve prolapse (TVP) is systolic displacement of one or more tricuspid leaflets beyond the tricuspid annulus, back toward the right atrium. It is closely related, both anatomically and in how it is recognized on echocardiography, to mitral valve prolapse — and the two frequently occur together.

A note on sourcing before starting: neither the 2020 ACC/AHA nor the 2025 ESC/EACTS guideline treats TVP as a distinct diagnostic entity. Searching both documents directly, “myxomatous disease” and leaflet prolapse are mentioned only in passing, as one of several listed causes of primary tricuspid regurgitation — with no dedicated diagnostic criteria, severity thresholds, or discussion of the kind given to mitral valve prolapse. This page is therefore built from standard echocardiography teaching (as it must be, given the guideline silence), and leans on the Mitral Valve Prolapse tutorial for the closely related mitral-side detail, and on the Tricuspid Regurgitation tutorial for grading any resulting regurgitation.

Types

The same two-way classification used for mitral valve prolapse applies here:

• Mid-to-late systolic prolapse — leaflet displacement beginning partway through systole
• Holosystolic (pansystolic) prolapse — leaflet displacement present throughout systole

Echocardiographic Findings

M-Mode

• Mid-to-late systolic hammocking — the leaflet shows a sagging motion during systole, beginning partway through
• Holosystolic hammocking — continuous leaflet displacement beyond the annular plane throughout the entirety of systole

2D Echocardiography

Any of the three tricuspid leaflets — septal, anterior, or posterior — can prolapse individually, or in combination, above the tricuspid annulus.

Optimal views:

• Apical four-chamber view
• Parasternal right ventricular inflow tract view

As with mitral valve prolapse, view selection matters: a leaflet that appears to prolapse in one view but not another warrants a second look, since foreshortening or an oblique imaging plane can create a false impression of leaflet displacement across the annular plane.

Doppler

Tricuspid regurgitation is a common accompanying finding, and — mirroring the pattern seen with mitral valve prolapse — is typically late systolic, timed to when the prolapsing leaflet crosses the annular plane rather than present from the start of systole. See the Tricuspid Regurgitation tutorial for the full grading approach, including the vena contracta, EROA, and regurgitant volume thresholds used to assess severity.

Important Considerations

• Isolated TVP is rare. It is frequently found together with mitral valve prolapse, reflecting a shared underlying myxomatous process affecting connective tissue across more than one valve.
• Careful evaluation of the mitral valve is recommended whenever TVP is identified — and, by the same logic, the tricuspid valve is worth a deliberate look whenever MVP is found, even if it wasn’t the primary reason for the study.
• Given how sparsely this entity is covered in the current major guidelines, management of any resulting TR follows the same general approach described in the Tricuspid Regurgitation tutorial — there is no TVP-specific intervention framework distinct from that.
• TVP is not Ebstein’s anomaly, and the two shouldn’t be conflated despite both being tricuspid valve pathologies with regurgitation — TVP involves a normally-positioned annulus with prolapsing leaflets, while Ebstein’s Anomaly involves apical displacement of the leaflet hinge points themselves, a fundamentally different mechanism.