From the Guidelines
The tricuspid valve appears normal with only trivial regurgitation, and no intervention is required based on these findings, as indicated by the 2017 ESC/EACTS guidelines for the management of valvular heart disease 1. The inferior vena cava (IVC) has a normal caliber of 1.3 cm with greater than 50% respiratory variation, indicating normal right atrial pressure, which is estimated at 3 mmHg.
Key Findings
- The tricuspid regurgitation velocity is 1.2 m/s, which is within normal limits.
- There is no evidence of tricuspid stenosis.
- The IVC size with appropriate respiratory collapse further confirms adequate right heart filling pressures. These findings collectively suggest normal right heart hemodynamics with no significant tricuspid valve pathology.
Clinical Implications
According to the 2014 AHA/ACC guideline for the management of patients with valvular heart disease 1, trivial tricuspid regurgitation is a physiologic finding present in most healthy individuals. Regular cardiac follow-up with routine echocardiography is appropriate to monitor for any changes over time, but no specific treatment is indicated based on these normal findings. The European Society of Cardiology guidelines also support this approach, emphasizing the importance of monitoring and individualized management 1.
Management
No specific treatment is required for the trivial tricuspid regurgitation, and the focus should be on regular monitoring and maintenance of overall cardiovascular health. In the absence of any symptoms or significant tricuspid valve pathology, no surgical or percutaneous intervention is necessary, as stated in the 2017 ESC/EACTS guidelines 1. Regular follow-up with a cardiologist and routine echocardiography will help to identify any potential changes or developments in the tricuspid valve or right heart function.
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 3
- Functional TR, the most common form of TR, is caused by cardiomyopathies, LV valve disease, or pulmonary disease 3
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
- Diminished respiratory variation in IVC diameter and systolic pulmonary artery pressure are independent markers of volume overload in patients with severe TR 4
- The distance between the lead-implanted site and tricuspid valve annulus is a predictor of TR deterioration after left bundle branch pacing 5
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
- Transcatheter tricuspid valve repair/replacement is an emerging therapy for high-risk patients with TR who would otherwise have a dismal clinical prognosis 3, 6
Epidemiology and Pathophysiology of Tricuspid Regurgitation
- Significant TR is a common finding, affecting about one in twenty-five subjects among the elderly and presenting more frequently in women than in men 6
- TR is a multifactorial disorder, resulting from maladaptive right ventricular remodeling secondary to pulmonary hypertension or from atrial fibrillation leading to dilation of the right atrium, tricuspid annulus and base of the right ventricle, with pathological TV coaptation 6
- Appreciable evidence suggests that significant TR leads to worsening prognosis regardless of the underlying etiology and should be addressed as a separate therapeutic target 6