Inferior vena cava in tricuspid insufficiency

The long axis view of the inferior vena cava (IVC) is obtained from the subcostal window (panel A); the hepatic veins (HV), and the entrance of the IVC into the right atrium (RA) are seen. Color flow Doppler (red) demonstrates retrograde systolic flow into the IVC and HV (panel B). Pulsed Doppler shows loss of normal systolic forward flow with exaggerated reversal of flow and an exaggerated V wave with inspiration (panel C). In addition to demonstrating systolic pulsations of the IVC, intavenous upper extremity saline contrast can be used detect retrograde systolic flow into the hepatic veins (panel D).