Isolated tricuspid regurgitation in structurally normal fetal hearts: a systematic review

Tricuspid regurgitation (TR) is increasingly identified during routine fetal echocardiography. Mild, transient TR may occur in structurally normal hearts, but in some cases, it reflects early hemodynamic imbalance or evolving pathology. This review summarizes current evidence on whether fetal TR in structurally normal hearts is clinically meaningful or simply a physiological finding.

A structured literature search was performed in PubMed/MEDLINE and Embase for studies published in English between January 2016 and January 2026. The search was limited to studies published from 2016 onward to ensure inclusion of data reflecting contemporary ultrasound technology and current fetal echocardiographic practice. Earlier studies were reviewed for background context but excluded from the systematic analysis to maintain methodological consistency. Search strategies combined descriptors related to fetal TR, Doppler or echocardiographic assessment, and structurally normal cardiac anatomy. We included original studies evaluating TR in fetuses with structurally normal hearts. Studies involving congenital heart disease (CHD), chromosomal abnormalities, mixed fetal-postnatal data without separable fetal results, or non-original publications were excluded. Eligible articles underwent full-text review, and data were extracted qualitatively for narrative synthesis.

A total of 42 records were identified through database searching, and 5 studies met the eligibility criteria after screening and removal of duplicates. All included studies evaluated TR in 845 fetuses with structurally normal hearts. Across cohorts, isolated TR was generally mild, transient, and most frequently detected in late gestation. None of the studies demonstrated an association between isolated TR and structural CHD, chromosomal abnormalities, or adverse perinatal outcomes. When follow-up echocardiography was available, TR typically regressed or resolved before delivery, and neonatal examinations were overwhelmingly normal.

Available evidence suggests that isolated TR in fetuses with normal cardiac anatomy is a benign finding, particularly when detected in the third trimester. Across the included studies, TR did not correlate with structural heart disease or clinically relevant postnatal complications. Overall, isolated fetal TR appears to behave as a physiological or self-limited Doppler observation rather than a marker of underlying pathology. However, given the limited number of studies, further research is needed to refine diagnostic thresholds and clinical interpretation.