Abstract: Echocardiography plays an important role in the diagnosis of pathological tricuspid regurgitation (TR). Real-time three-dimensional echocardiography can fully display the tricuspid valve and its surrounding structures, the new index of vena contracta area derived from its color Doppler technology can accurately measure the instantaneous regurgitant flow, which is more valuable in diagnosing severe TR and determining its cutoff value. Especially, in transcatheter tricuspid surgery, real-time three-dimensional echocardiography plays an important role. This review summarizes the application and shortcomings of real-time three-dimensional echocardiography in patients with TR, and provides a reference for optimizing the clinical evaluation of TR.