What is the diagnosis for a patient with a tricuspid valve (TV) showing trivial regurgitation, normal structure, and a tricuspid regurgitation (TR) velocity of 1.2 meters per second (m/s)?

From the Guidelines

The tricuspid valve function appears normal with only physiologic (trivial) regurgitation, and no intervention is required as these findings represent normal cardiac hemodynamics. The inferior vena cava (IVC) caliber is 1.3 cm, which is within normal limits, suggesting normal right atrial pressure, as an IVC diameter < 2.1 cm is considered normal 1. This is confirmed by the measured right atrial pressure of 3 mmHg, which is also normal. The tricuspid regurgitation velocity is 1.2 m/s, indicating a low pressure gradient across the valve. According to the European Association of Cardiovascular Imaging, a tricuspid regurgitation velocity of 1.2 m/s is consistent with mild or trivial regurgitation 1.

Some key points to consider in this assessment include:

• The absence of stenosis and the normal structure of the tricuspid valve
• The trivial regurgitation, which is frequently detected by echocardiography in normal subjects 1
• The normal IVC size and low right atrial pressure, indicating adequate right heart function without evidence of right-sided heart failure or pulmonary hypertension
• The low TR velocity, which further confirms the absence of elevated right ventricular systolic pressure

Based on these findings and the guidelines from the European Society of Cardiology 1 and the European Association of Cardiovascular Imaging 1, no intervention is required for the tricuspid valve, and these parameters should be monitored during routine cardiac follow-up.

From the Research

Tricuspid Valve Structure and Function

• The tricuspid valve is a complex structure with a broad anatomical variability 2
• Tricuspid regurgitation (TR) is present in 1.6 million individuals in the United States and 3.0 million people in Europe, with functional TR being the most common form 3
• TR can be classified into two basic categories: primary and secondary or functional TR, with the latter being the most prevalent 4, 2

Diagnosis and Assessment of Tricuspid Regurgitation

• Echocardiography can assess the TR etiology/severity, measure RA and RV size and function, estimate pulmonary pressure, and characterize LV disease 3
• Two- and three-dimensional echocardiography allow for a comprehensive assessment of TR severity and mechanisms 4
• TR velocity and gradient can be used to assess the severity of TR, with a TR velocity of 1.2 m/s indicating trivial regurgitation

Management and Treatment of Tricuspid Regurgitation

• Management includes diuretics, ACE inhibitors, and aldosterone antagonists 3
• Surgical annuloplasty or valve replacement should be considered in patients with progressive RV dilatation without severe LV dysfunction and pulmonary hypertension 3
• Transcatheter repair/replacement is possible in patients with a LVEF <40%, dilated annuli, and impaired RV function 3, 2
• Percutaneous TV therapy is an emerging therapy for high-risk patients with TR who would otherwise have a dismal clinical prognosis 5, 2

Prognosis and Outcomes

• Significant TR is an independent predictor of reduced event-free and overall survival 4
• The five-year survival with severe TR and HFrEF is 34% 3
• Appreciable evidence suggests that significant TR leads to worsening prognosis regardless of the underlying etiology and should be addressed as a separate therapeutic target 2