What does hepatic venous flow reversal indicate in terms of tricuspid regurgitation?

The indication of hepatic venous flow reversal is directly related to the severity of tricuspid regurgitation (TR). In the context of severe TR, the reversal of blood flow in the hepatic veins occurs due to the significant pressure gradient created by right atrial volume overload. When the tricuspid valve fails to close properly during ventricular systole, blood can flow back into the right atrium from the right ventricle. This increased volume and pressure in the right atrium can then propagate backward into the venous system, notably affecting the hepatic veins.

In severe TR, the pressure in the right atrium can rise significantly, leading to abnormal flow patterns in the hepatic veins. The resulting reversal indicates substantial hemodynamic compromise and reflects the underlying severity of the regurgitant flow across the tricuspid valve. Therefore, the presence of hepatic venous flow reversal is a strong indicator of severe tricuspid regurgitation, confirming the diagnosis through echocardiographic assessment.