From the Guidelines
The tricuspid valve assessment shows normal structure with only trivial regurgitation and no stenosis, indicating no significant pathology and no need for intervention, as supported by the European Society of Cardiology guidelines on valvular heart disease 1. The inferior vena cava (IVC) caliber is 1.3 cm, which is within normal limits, suggesting normal right atrial pressure. 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. Key points to consider in this assessment include:
- Trivial tricuspid regurgitation is frequently detected in normal subjects by echocardiography, as noted in the guidelines 1
- The absence of stenosis and the normal IVC caliber suggest normal right heart hemodynamics
- The low TR velocity and normal right atrial pressure indicate no significant pressure overload or volume overload on the right ventricle Based on these findings, the tricuspid valve function appears normal with no significant pathology. The right ventricular systolic pressure (RVSP) is likely normal given the low TR velocity, though the exact value is not provided. Considerations for management include:
- Regular cardiac follow-up with routine echocardiography to monitor for any changes over time
- No intervention is required for the tricuspid valve based on these echocardiographic parameters, as they represent normal physiological findings, in line with the guidelines on valvular heart disease management 1
From the Research
Tricuspid Valve Structure and Function
- The tricuspid valve is a complex structure that can be affected by various diseases, including tricuspid regurgitation and stenosis 2.
- Tricuspid regurgitation is frequently encountered and is most often secondary in nature, caused by annular dilatation and leaflet tethering from adverse right ventricular remodelling 2.
- The assessment and management of tricuspid valve disease have evolved substantially during the past several years, with a focus on non-invasive assessment and advanced imaging techniques such as three-dimensional echocardiography, MRI, and CT 2, 3, 4, 5, 6.
Imaging Techniques for Tricuspid Valve Disease
- Multimodality imaging, including echocardiography, plays a crucial role in patient selection for transcatheter tricuspid valve intervention (TTVI) and procedure planning 3, 6.
- Three-dimensional echocardiography has emerged as a cost-effective imaging modality for visualizing the tricuspid valve anatomy, defining the mechanism of tricuspid regurgitation, and measuring the size and geometry of the tricuspid annulus 4, 5.
- Transesophageal echocardiography and fluoroscopy imaging are key for guiding TTVI procedures, and fusion between these two modalities may further enhance the quality of procedure guiding 3, 6.
Treatment Options for Tricuspid Valve Disease
- The indications for tricuspid valve surgery to treat tricuspid regurgitation are related to the cause of the disorder, the context in which it is encountered, its severity, and its effects on right ventricular function 2.
- Novel transcatheter therapies have begun to emerge for the treatment of tricuspid regurgitation in patients who are deemed at high or prohibitive surgical risk 2, 3, 4.
- Percutaneous procedures present a viable alternative for patients who are categorized as high-risk surgical candidates, and developmental attention has been focused on the aortic and mitral valves, but few data are available about the feasibility and efficacy of minimally invasive tricuspid valve treatment 4.