Evaluation of tricuspid regurgitation (TR) was attempted by observing the blood flow pattern in the hepatic vein (HV), inferior vena cava dimension (IVCD), and hepatic vein dimension (HVD), with the use of a combined system of pulsed Doppler technique and two-dimensional echocardiography in 60 patients with valvular heart disease. For comparison, all patients underwent right ventriculography, by which TR was classified as mild, moderate, or severe. IVCD and HVD of the group with severe TR were significantly larger than those of the other groups (p less than 0.005). Several types of abnormal blood flow patterns in the HV were demonstrated in patients with atrial fibrillation. By these flow patterns, the severe or moderate TR groups could be differentiated from the mild TR group, because 21 of the 26 patients (81%) in the former group showed reverse hepatic flow during systole. Also, the Doppler shifts from baseline in the sound spectrogram correlated well with right atrial pressure (RAP) and right ventricular end-diastolic pressure (RVEDP) (r = -0.72, -0.64, p less than 0.001, respectively). This method is useful for rapidly evaluating considerable TR and for estimating RAP and RVEDP noninvasively.