From the Guidelines
The echocardiogram results indicate normal cardiac valve function with no significant abnormalities, and therefore, no valve-directed interventions are necessary. The mitral valve has a normal structure with a peak velocity of 1.2 m/s, peak gradient of 6 mmHg, and a valve area of 3.6 cm², which is within normal range 1. There is only trivial mitral regurgitation, which is clinically insignificant, as stated in the European Association of Cardiovascular Imaging recommendations for the echocardiographic assessment of native valvular regurgitation 1. The tricuspid valve also appears structurally normal with trivial regurgitation, and the inferior vena cava (IVC) caliber is 1.3 cm, indicating normal right atrial pressure estimated at 3 mmHg. The tricuspid regurgitation velocity is 1.2 m/s, suggesting normal right ventricular systolic pressure. The pulmonic valve is structurally normal with a peak velocity of 1.0 m/s and peak gradient of 4 mmHg, which are within normal limits.
Some key points to consider in the evaluation of valvular regurgitation include:
- Two-dimensional (2D) transthoracic echocardiography (TTE) is recommended as first-line imaging in valvular regurgitation 1
- The aetiology and mechanism of the regurgitation, including the dysfunction type, should be described according to the Carpentier’s classification of leaflet motion 1
- A careful assessment of the regurgitant jet by colour Doppler, using multiple views, can rapidly diagnose minimal regurgitation 1
- The use of a more quantitative method, such as vena contracta (VC) measurement and the proximal isovelocity surface area (PISA) method, is advised when feasible 1
Overall, the echocardiogram demonstrates normal cardiac valve function without evidence of stenosis or significant regurgitation, suggesting normal hemodynamics and no need for valve-directed interventions, as supported by the European Association of Cardiovascular Imaging recommendations 1.
From the Research
Valve Assessment
- The provided valve assessment data includes information on the mitral, tricuspid, and pulmonic valves, with details on structure, stenosis, regurgitation, and pressure gradients.
- For the mitral valve, the normal peak velocity is 1.2 m/s, with no stenosis and trivial regurgitation 2.
- The tricuspid valve shows normal structure, no stenosis, and trivial regurgitation, with a peak velocity of 1.2 m/s 3.
- The pulmonic valve has a normal structure, no stenosis, and no regurgitation, with a peak velocity of 1.0 m/s 4.
Echocardiographic Assessment
- Echocardiography plays a crucial role in the assessment of valve disease, including the evaluation of valve function, left ventricular function, and pulmonary congestion 2.
- The comprehensive stress echo assessment includes valve function, left ventricular global systolic and diastolic function, left atrial volume, pulmonary congestion, pulmonary arterial pressure, and right ventricular function 2.
- Recent guidelines recommend the evaluation of asymptomatic severe or symptomatic non-severe mitral regurgitation or stenosis with exercise stress and suspected low-flow, low-gradient severe aortic stenosis with reduced ejection fraction with low dose dobutamine stress 2.
Valve Disease Diagnosis
- The diagnosis of valve disease relies on echocardiographic assessment, with standards adopted to maintain accuracy and consistency across echocardiographic laboratories 4.
- The assessment of aortic stenosis, in particular, requires optimization of left ventricular outflow tract assessment, low flow, low gradient aortic stenosis with preserved ejection fraction, and a new classification of aortic stenosis by gradient, flow, and ejection fraction 4.
- A grading algorithm for an integrated and stepwise approach of aortic stenosis assessment in clinical practice is also recommended 4.