The process of right-heart catheterization under echocardiographic guidance. Echocardiography with an aortic short axis view was used to visualize the position of the catheter system. The catheter system was visualized entering the right atrium (A). The guide wire was slowly backed out to connect a pressure transducer to measure pressures in the right atrium. The pressure transducer was removed to allow introduction of the guide wire into the catheter system again. Adjust the direction of the guide wire to advance the catheter system pointing to the tricuspid valve (B) and then getting through it (C). The guide wire inside the catheter was then used to damage the tricuspid valve. Color Doppler was in action to visualize tricuspid valve regurgitation (D). The peak velocity was then evaluated by Pulsed Doppler. The catheter system was then repositioned at the entrance of the right atrium (E). The guide wire was removed and a pressure transducer connected to measure the pressure of the right atrium after valvular impairment.