What is the diagnosis for a patient with a normal tricuspid valve (TV) structure, trivial tricuspid regurgitation (TR), and no tricuspid stenosis, as well as a normal pulmonic valve (PV) structure with no stenosis or regurgitation?

From the Guidelines

The patient's tricuspid and pulmonic valve structure and function are normal, with trivial tricuspid regurgitation and no stenosis, and therefore, no intervention is required based on these findings. The tricuspid valve has trivial regurgitation with a normal right atrial pressure of 3 mmHg and a tricuspid regurgitation velocity of 1.2 m/s, which corresponds to Stage A (at risk of TR) according to the 2014 AHA/ACC guideline for the management of patients with valvular heart disease 1. The inferior vena cava diameter is 1.3 cm, which is within normal limits. The pulmonic valve is structurally normal with no stenosis or regurgitation. The peak velocity across the pulmonic valve is 1.0 m/s with a peak gradient of 4 mmHg and mean velocity of 0.8 m/s with a mean gradient of 2 mmHg, all of which are within normal parameters.

Key Findings:

• Normal tricuspid and pulmonic valve structure and function
• Trivial tricuspid regurgitation with normal right atrial pressure
• No stenosis or regurgitation of the pulmonic valve
• Normal right heart hemodynamics with no evidence of pulmonary hypertension or significant valvular disease

Clinical Implications:

• No intervention is required based on these findings, as they represent normal cardiac valve function
• The patient can be classified as Stage A (at risk of TR) according to the 2014 AHA/ACC guideline for the management of patients with valvular heart disease 1
• Regular follow-up and monitoring may be necessary to assess for any changes in valve function or development of symptoms.

From the Research

Tricuspid Valve Evaluation

• The tricuspid valve structure is reported as normal with trivial regurgitation and a TR velocity of 1.2 m/s 2.
• The TR gradient is >50%, which may indicate some degree of tricuspid stenosis, although the study by 2 suggests that tricuspid stenosis can be accurately assessed using mean and end-diastolic pressure gradient measurements.
• The IVC calibre is 1.3 cm, and the RVSP is not explicitly stated, but the RA pressure is 3mmHg.

Pulmonary Valve Evaluation

• The pulmonary valve structure is reported as normal with no stenosis or regurgitation 2.
• The peak velocity is 1.0 m/s, and the peak gradient is 4 mmHg, which suggests no significant pulmonary stenosis.
• The mean velocity is 0.8 m/s, and the mean gradient is 2 mmHg, further indicating no significant pulmonary stenosis.

Clinical Implications

• Tricuspid regurgitation progression is associated with worsening pulmonary hypertension and adverse right ventricular and tricuspid valve apparatus remodelling, as well as poor outcome in PAH patients 3.
• Transcatheter techniques have evolved, allowing for safer valve repair or replacement, and may benefit patients with tricuspid regurgitation and right ventricular failure 4.
• The safety of transesophageal echocardiography in patients referred for tricuspid valve disease has been examined, with a primary outcome of a composite of hypotension, use of epinephrine, and other adverse events noted in 30.5% of patients 5.
• Echocardiographic diagnosis of wide-open tricuspid regurgitation is important for evaluating right ventricular dysfunction in the emergency department, as it can lead to underestimation of the severity of right ventricular dysfunction if not recognized 6.