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 indicated by the measured right atrial pressure of 3 mmHg, which is also normal 1. The tricuspid regurgitation velocity is 1.2 m/s, indicating a low pressure gradient across the valve. According to the 2014 AHA/ACC guideline for the management of patients with valvular heart disease, these findings are consistent with Stage A, where the patient is at risk of TR but has no or trace TR, and normal valve hemodynamics 1.
Key Findings
- Normal tricuspid valve structure
- Trivial regurgitation
- No stenosis
- IVC caliber: 1.3 cm (within normal limits)
- Right atrial pressure: 3 mmHg (normal)
- Tricuspid regurgitation velocity: 1.2 m/s (low pressure gradient)
Clinical Implications
The normal IVC size and low right atrial pressure indicate adequate right heart function without evidence of right-sided heart failure or pulmonary hypertension, as supported by the guidelines on the management of valvular heart disease 1. The low TR velocity further confirms the absence of elevated right ventricular systolic pressure. These parameters should be monitored during routine cardiac follow-up, but currently show no pathological changes requiring treatment, in line with the recommendations for patients with valvular heart disease 1.
From the Research
Tricuspid Valve Structure and Function
- The tricuspid valve is a complex structure that can be affected by various diseases, including tricuspid regurgitation and stenosis 2.
- Tricuspid regurgitation is frequently encountered and is most often secondary in nature, caused by annular dilatation and leaflet tethering from adverse right ventricular remodelling 2.
- The assessment of tricuspid valve disease requires a comprehensive approach, including non-invasive imaging techniques such as echocardiography, MRI, and CT 2, 3, 4, 5.
Tricuspid Regurgitation
- Tricuspid regurgitation is a significant predictor of adverse outcomes, particularly in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR) 6.
- The TRI-SCORE is a clinical scoring system that can be used to predict adverse outcomes in patients with tricuspid regurgitation and concomitant aortic stenosis undergoing TAVR 6.
- Transcatheter therapies have emerged as a viable alternative for patients with severe tricuspid regurgitation who are deemed high-risk for surgical intervention 2, 3, 4.
Imaging Techniques
- Three-dimensional echocardiography has emerged as a cost-effective imaging modality for visualizing the tricuspid valve anatomy, defining the mechanism of tricuspid regurgitation, and planning surgical repair or guiding transcatheter interventional procedures 3, 4, 5.
- Multimodality imaging, including transesophageal echocardiography and fluoroscopy, plays a crucial role in patient selection, procedure planning, and guiding transcatheter tricuspid valve intervention (TTVI) 3.