From the Guidelines
The tricuspid valve is normal with trivial regurgitation, and no intervention is needed as all parameters are within normal limits. The inferior vena cava (IVC) caliber is 1.3 cm, which is within normal limits, suggesting normal right atrial pressure, as an IVC diameter < 2.1 cm is considered normal 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. Based on these findings, the right ventricular systolic pressure (RVSP) is likely normal, as the TR velocity is low. Some key points to consider in this assessment include:
- Trivial tricuspid regurgitation is frequently detected by echocardiography in normal subjects, and pathological TR is more often functional rather than due to a primary valve lesion 1
- The grading of tricuspid regurgitation severity can be based on parameters such as qualitative, semi-quantitative, and quantitative measures, including colour flow TR jet, CW signal of TR jet, VC width, PISA radius, hepatic vein flow, tricuspid inflow, EROA, and R Vol 1
- In this case, the trivial regurgitation is a common finding even in healthy individuals and is not clinically significant, and regular follow-up with routine cardiac evaluation is sufficient, as there are no concerning features that would suggest right-sided heart disease or pulmonary hypertension.
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, with functional TR being the most common form 3
- TR can be primary or secondary, with secondary TR being caused by cardiomyopathies, LV valve disease, or pulmonary disease 3
Diagnosis and Treatment 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
- Management of TR includes diuretics, ACE inhibitors, and aldosterone antagonists, with surgical annuloplasty or valve replacement considered in patients with progressive RV dilatation without severe LV dysfunction and pulmonary hypertension 3
- Transcatheter repair/replacement is an emerging therapy for high-risk patients with TR who would otherwise have a dismal clinical prognosis 3, 4, 2
Tricuspid Regurgitation Severity and Outcomes
- Significant TR can lead to irreversible myocardial damage and adverse outcomes, with a five-year survival rate of 34% in patients with severe TR and HFrEF 3
- A new outcomes-based "massive" grade of TR has been proposed, with a vena contracta (VC) cutoff value of >0.92 cm associated with worse survival and increased mortality 5
- Patients with massive TR may derive the greatest benefit from emerging percutaneous therapies 5
Tricuspid Valve Imaging and Intervention
- Tricuspid valve abnormalities in congenital heart disease comprise a wide spectrum, with the most common being Ebstein anomaly and tricuspid valve dysplasia 6
- Surgical treatment of tricuspid valve disease remains the mainstay of therapy, with primary catheter-based interventions uncommon 6
- Tricuspid valve-in-valve catheter-based replacement may be an option for patients with a bioprosthesis 6