To verify the ability of Pulsed Doppler Echocardiography (PDE) to detect flow abnormalities in tricuspid insufficiency (TI), 27 normal controls and 83 heart patients (pts) were studied. The latter group underwent an invasive diagnostic evaluation. The PDE examination did not reveal any significant systolic flow alteration in the normal controls. However, in the heart patients, a systolic turbulence was recorded within the right atrium both on audio and on graphic system (Time Interval Histogram-TIH) in 28 cases. Angiography showed tricuspid regurgitation in 24 pts. The sensitivity of PDE was 92%, the specificity was 93% and the predictive value was 96%. There were two false negative and four false positive cases. In conclusion, Pulsed Doppler Echocardiography is a highly reliable technique for the qualitative diagnosis of tricuspid insufficiency in patients with acquired heart disease. Left-to-Right shunts, namely left-to-right atrium and left ventricle-to-right atrium, can create flow disturbances that mimic tricuspid insufficiency. No criteria were identified, which correlated well with the angiographic severity of the tricuspid regurgitation.