From the Guidelines
The tricuspid valve assessment shows normal structure with trivial regurgitation and no stenosis, and therefore, no intervention or follow-up is required for these normal findings, as trivial tricuspid regurgitation is considered a normal variant in most cases and does not indicate valvular disease. The inferior vena cava (IVC) caliber is 1.3 cm, which is within normal limits, suggesting normal right atrial pressure, as indicated by the European Association of Cardiovascular Imaging 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 during regurgitation. This low velocity suggests normal right ventricular systolic pressure (RVSP).
According to the 2017 ESC/EACTS guidelines for the management of valvular heart disease 1, the indications for surgery in tricuspid regurgitation are based on the severity of the regurgitation and the presence of symptoms. However, in this case, the trivial regurgitation and normal IVC size and right atrial pressure do not meet the criteria for intervention. The American College of Cardiology/American Heart Association guidelines for the management of patients with valvular heart disease also support this approach, emphasizing the importance of integrating multiple parameters to assess the severity of tricuspid regurgitation 1.
Overall, these findings represent a normal tricuspid valve with physiologic trivial regurgitation, which is a common and benign finding in healthy individuals. The normal IVC size and right atrial pressure further support that there is no significant right-sided heart dysfunction. Therefore, no intervention or follow-up is required for these normal findings.
From the Research
Tricuspid Valve Structure and Function
- The tricuspid valve is a complex structure that plays a crucial role in maintaining cardiac function 2, 3.
- Tricuspid regurgitation (TR) is a common valvular disease that can be classified into primary and secondary TR, with secondary TR being more common 3.
- TR can be caused by various factors, including cardiomyopathies, LV valve disease, or pulmonary disease 2.
Diagnosis and Assessment of Tricuspid Regurgitation
- Echocardiography is a key diagnostic tool for assessing TR severity and mechanisms 2, 3, 4.
- The evaluation of TR severity can be challenging, and a new outcomes-based "massive" grade has been proposed to refine the definition of severe TR 5.
- Multi-modality imaging, including echocardiography, is essential for determining the mechanism, severity, and potential treatment options of TR 4.
Treatment and Management of Tricuspid Regurgitation
- Management of TR includes diuretics, ACE inhibitors, and aldosterone antagonists 2.
- Surgical annuloplasty or valve replacement should be considered in patients with progressive RV dilatation without severe LV dysfunction and pulmonary hypertension 2.
- Transcatheter repair/replacement is an emerging therapy for high-risk patients with TR who would otherwise have a dismal clinical prognosis 2, 4.
- Percutaneous transcatheter repair and replacement devices have been developed to treat patients with significant TR who are at high surgical risk 4.
Tricuspid Valve Disease in Special Populations
- Tricuspid valve abnormalities in congenital heart disease comprise a wide spectrum, with the most common being Ebstein anomaly and tricuspid valve dysplasia 6.
- Tricuspid valve dysfunction may also be secondary to other types of congenital heart disease, including functional tricuspid regurgitation seen in right heart volume overload conditions 6.