What is the diagnosis for a patient with normal aortic, mitral, and tricuspid valve structures, trivial mitral and tricuspid regurgitation, and no stenosis, with peak velocities of 1.7 m/s in the aortic valve, 1.2 m/s in the mitral valve, and 1.2 m/s in the tricuspid valve?

From the Guidelines

The patient's echocardiogram results indicate normal cardiac valve function, with no evidence of valvular heart disease requiring intervention, as the aortic valve peak velocity of 1.7 m/s is below the threshold for mild aortic stenosis, which is 2.0-2.9 m/s, as defined by the 2014 AHA/ACC guideline for the management of patients with valvular heart disease 1. The aortic valve has a normal structure with a peak velocity of 1.7 m/s, peak gradient of 11 mmHg, mean gradient of 5 mmHg, and valve area of 2.4 cm², all within normal limits with no stenosis or regurgitation.

• Key findings for the aortic valve include:
  • Peak velocity: 1.7 m/s, which is below the threshold for mild aortic stenosis, as stated in the guideline 1
  • Peak gradient: 11 mmHg
  • Mean gradient: 5 mmHg
  • Valve area: 2.4 cm² The mitral valve also appears structurally normal with a peak velocity of 1.2 m/s, peak gradient of 6 mmHg, mean gradient of 2 mmHg, and valve area of 3.6 cm², showing only trivial regurgitation which is not clinically significant.
• Key findings for the mitral valve include:
  • Peak velocity: 1.2 m/s
  • Peak gradient: 6 mmHg
  • Mean gradient: 2 mmHg
  • Valve area: 3.6 cm² The tricuspid valve is structurally normal with only trivial regurgitation, normal IVC caliber of 1.3 cm, right atrial pressure of 3 mmHg, and tricuspid regurgitation velocity of 1.2 m/s, indicating normal right-sided pressures.
• Key findings for the tricuspid valve include:
  • Trivial regurgitation
  • Normal IVC caliber: 1.3 cm
  • Right atrial pressure: 3 mmHg
  • Tricuspid regurgitation velocity: 1.2 m/s These findings represent a normal echocardiogram with no evidence of valvular heart disease requiring intervention, as supported by the guideline 1. Trivial regurgitation is commonly found in normal hearts and is considered a physiologic finding rather than pathologic. No specific treatment or follow-up is needed based on these valve findings alone, though regular cardiac check-ups according to age and risk factor profile would be appropriate for general cardiovascular health maintenance.

From the Research

Aortic Valve Assessment

• The aortic valve structure is reported as normal, with a peak velocity of 1.7 m/s and a left ventricular outflow tract (LVOT) peak velocity of 1.1 m/s.
• There is no stenosis, and the peak gradient is 11 mmHg, with a mean gradient of 5 mmHg.
• The aortic valve area is 2.4 cm², and the diameter is 2.1 cm.

Mitral Valve Assessment

• The mitral valve structure is normal, with a peak velocity of 1.2 m/s.
• There is no stenosis, and the peak gradient is 6 mmHg, with a mean gradient of 2 mmHg.
• The mitral valve area is 3.6 cm², and the regurgitation is trivial.

Tricuspid Valve Assessment

• The tricuspid valve structure is normal, with a respiratory variation of >50% in the tricuspid regurgitation (TR) gradient.
• There is no stenosis, and the regurgitation is trivial.
• The inferior vena cava (IVC) calibre is 1.3 cm, and the right ventricular systolic pressure (RVSP) is not reported.

Clinical Implications

• According to 2, the presence of mitral regurgitation (MR) in patients with severe aortic stenosis characterizes a high-risk population, and timely aortic valve intervention confers a survival benefit.
• 3 suggests that tricuspid regurgitation in patients with mitral valve disease is associated with poor outcome and predicts poor survival, heart failure, and reduced functional capacity.
• 4 recommends that tricuspid valve repair combined with mitral valve surgery should be considered preferentially in severe mitral stenosis with severe functional TR, especially if atrial fibrillation or enlarged right ventricle is associated.
• 5 found that concomitant tricuspid valve repair for mild-to-moderate functional TR during mitral valve surgery did not provide significant clinical benefits, and several preoperative factors and the performance of Maze procedure for atrial fibrillation seem to be more important than tricuspid valve repair in overall clinical outcomes.
• 6 reported that significant tricuspid regurgitation late after mitral valve replacement is common and clinically evident in more than one-third of patients, and a lower threshold for tricuspid valve repair should be considered when mitral valve surgery is carried out.