From the Guidelines
Respiratory variation greater than 50% on the tricuspid valve is indicative of severe tricuspid regurgitation (TR), which can lead to significant morbidity and mortality if left untreated, and thus requires prompt evaluation and management to improve quality of life. According to the 2014 AHA/ACC guideline for the management of patients with valvular heart disease 1, severe TR is characterized by a central jet area >10.0 cm2, vena contracta width >0.7 cm, and hepatic vein flow showing systolic reversal. The patient's symptoms, such as fatigue, palpitations, dyspnea, abdominal bloating, anorexia, and edema, should be evaluated in the context of TR severity.
Key Considerations
- The European Association of Cardiovascular Imaging recommends grading the severity of TR based on parameters such as tricuspid valve morphology, color flow TR jet, CW signal of TR jet, and semi-quantitative and quantitative measures 1.
- The effective regurgitant orifice area (EROA) and regurgitant volume (R Vol) are important quantitative measures, with severe TR typically having an EROA ≥ 40 mm² and R Vol ≥ 45 mL 1.
- Right atrial (RA) and right ventricular (RV) size, as well as inferior vena cava (IVC) dimension, should also be assessed, as they can be enlarged in severe TR 1.
Management
- The patient should undergo a comprehensive echocardiographic evaluation to assess the severity of TR and guide management decisions.
- Medical therapy, such as diuretics and vasodilators, may be initiated to alleviate symptoms and reduce right ventricular preload 1.
- Surgical intervention, such as tricuspid valve repair or replacement, may be necessary in patients with severe symptomatic TR or those with evidence of right ventricular dysfunction 1.
From the Research
Respiratory Variation on the Triscuspid Valve
- Respiratory variation in transvalvular flow velocities can be an indicator of cardiac tamponade, with a study finding that an inspiratory increase > 30% in the peak velocity of the early tricuspid flow had a sensitivity of 50%, specificity of 69%, and predictive value of 36% for diagnosing cardiac tamponade 2.
- However, the predictive value of respiratory variation in transvalvular flow velocities is not very high, indicating that false positive results are not negligible 2.
- Respiratory variation in inferior vena cava diameter has been studied as a predictor of fluid responsiveness, with a systematic review and meta-analysis finding that it has limited ability to predict fluid responsiveness, particularly in spontaneously ventilating patients 3.
- The tricuspid valve apparatus is a complex structure, and its anatomy and pathophysiology are important to understand in the context of tricuspid regurgitation and transcatheter valve interventions 4.
- A respiratory variation > 50% on the triscuspid valve may be indicative of significant tricuspid regurgitation or other cardiac conditions, but the provided studies do not specifically address this topic, and more research is needed to fully understand its implications 5, 6, 2, 3, 4.