From the Guidelines
The tricuspid valve assessment shows normal structure with trivial regurgitation and no stenosis, indicating no need for intervention 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 confirmed by the measured right atrial pressure of 3 mmHg, which is also normal 1. 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.
The presence of trivial tricuspid regurgitation is a common finding even in healthy individuals and is not clinically significant, as noted in the guidelines on the management of valvular heart disease by the European Society of Cardiology 1. These findings suggest normal right heart function without evidence of pulmonary hypertension or right-sided heart failure. Key points to consider include:
- Normal IVC caliber and right atrial pressure
- Low tricuspid regurgitation velocity
- Absence of stenosis
- Trivial regurgitation, which is often seen in normal subjects 1
Regular cardiac follow-up with routine echocardiography is recommended according to standard clinical practice guidelines, to monitor for any potential changes in tricuspid valve function or right heart pressures. However, based on current findings, no specific intervention for the tricuspid valve is required.
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 of tricuspid valve disease requires a comprehensive evaluation, including non-invasive imaging techniques such as echocardiography, MRI, and CT 2, 3.
Tricuspid Regurgitation
- Tricuspid regurgitation is an independent predictor of death, and its severity can be quantified using echocardiography 4.
- The mechanism of tricuspid regurgitation can be defined using 3D echocardiography, which provides a detailed visualization of the tricuspid valve anatomy 4.
- Transcatheter tricuspid valve intervention (TTVI) is a emerging therapy for tricuspid regurgitation, and multimodality imaging plays a crucial role in patient selection, procedure planning, and guiding the procedure 3.
Imaging Techniques
- 3D echocardiography is a cost-effective imaging modality that can be used to visualize the tricuspid valve anatomy, define the mechanism of tricuspid regurgitation, and measure the size and geometry of the tricuspid annulus 4.
- 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.
- Echocardiographic evaluation is essential for assessing valve function after transcatheter tricuspid valve-in-valve replacement (TVIV) 5.
Treatment Options
- Tricuspid valve surgery is indicated for patients with severe tricuspid regurgitation, and the threshold for restrictive ring annuloplasty repair of secondary tricuspid regurgitation has decreased over time 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.
- TTVI can be categorized into different types, including direct or indirect tricuspid restrictive annuloplasty, direct or indirect restoration of leaflet coaptation, heterotopic tricuspid valve implantation, and transcatheter tricuspid valve replacement 3.