From the Guidelines
The tricuspid valve is functioning normally, with no indication of stenosis, significant regurgitation, or other abnormalities that would necessitate intervention, as evidenced by the trivial regurgitation and normal hemodynamic parameters 1. The valve structure is normal, and it exhibits the expected respiratory variation in gradient, with a greater than 50% change in pressure gradient across the valve with respiration.
- Key findings include:
- Normal valve structure
- Greater than 50% respiratory variation in gradient
- No stenosis
- Trivial tricuspid regurgitation with a velocity of 1.2 m/s
- Normal inferior vena cava diameter of 1.3 cm
- Right atrial pressure within the normal range at 3 mmHg According to the 2014 AHA/ACC guideline for the management of patients with valvular heart disease 1, these findings are consistent with Stage A, "At risk of TR," where there is no or trace TR, and no hemodynamic consequences or symptoms are present. Given these normal findings, no specific intervention or monitoring beyond routine cardiac follow-up is required, as the tricuspid valve is functioning within normal parameters, and there is no evidence of significant valvular disease or right heart dysfunction 1.
From the Research
Tricuspid Valve Structure and Function
- The tricuspid valve is a complex structure that plays a crucial role in maintaining unidirectional blood flow through the right side of the heart 2.
- Proper function of the tricuspid valve is essential to prevent undesired backflow of blood from the right ventricle into the right atrium during systole 2.
Tricuspid Regurgitation
- Tricuspid regurgitation (TR) is a common valvular heart disease that affects approximately 1.6 million individuals in the United States and 3.0 million people in Europe 3.
- Functional TR is the most common form of TR, caused by cardiomyopathies, LV valve disease, or pulmonary disease 3.
- TR can lead to significant morbidity and poor quality of life, with a five-year survival rate of 34% in patients with severe TR and heart failure with reduced ejection fraction (HFrEF) 3.
Diagnosis and Treatment
- Echocardiography is a useful tool for assessing TR etiology and severity, measuring right atrial and ventricular size and function, estimating pulmonary pressure, and characterizing left ventricular disease 3.
- Treatment options for TR include diuretics, ACE inhibitors, and aldosterone antagonists, as well as surgical annuloplasty or valve replacement in patients with progressive right ventricular dilatation without severe left ventricular dysfunction and pulmonary hypertension 3.
- Transcatheter repair or replacement is a emerging therapy for high-risk patients with TR, offering a safer alternative to traditional surgical approaches 3, 4, 5, 6.
Transcatheter Tricuspid Valve Repair/Replacement
- Transcatheter tricuspid valve repair/replacement is a minimally invasive procedure that has shown promise in treating patients with severe TR who are at high risk for surgical complications 4, 5, 6.
- The TriClip device is an example of a transcatheter edge-to-edge repair device that has been used to treat TR in high-risk patients 5.
- Studies have demonstrated the safety and efficacy of transcatheter tricuspid valve repair/replacement in improving symptoms and quality of life in patients with severe TR 4, 5, 6.