From the Guidelines
The tricuspid valve is normal with trivial regurgitation, and no intervention is needed 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 an IVC diameter < 2.1 cm is considered normal 1. 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. Based on these findings, the right ventricular systolic pressure (RVSP) is likely normal, as the TR velocity is low.
- The trivial regurgitation is a common finding even in healthy individuals and is not clinically significant, as stated in the guidelines on the management of valvular heart disease 1.
- The normal IVC size and normal right atrial pressure further support that there is no right-sided heart dysfunction or pulmonary hypertension.
- Regular cardiac follow-up as per standard guidelines is appropriate, but no specific treatment is required for the tricuspid valve based on these findings.
- According to the recommendations for the echocardiographic assessment of native valvular regurgitation, the parameters for grading the severity of TR are well within the mild category, and the patient's condition does not meet the criteria for moderate or severe TR 1.
From the Research
Tricuspid Valve Structure and Function
- The tricuspid valve has a broad anatomical variability 2
- Tricuspid regurgitation (TR) can be classified into two basic categories: primary and secondary TR, with secondary TR being more common 3
- Secondary TR occurs due to tricuspid annular dilatation, right heart failure, and/or pulmonary hypertension 3
Tricuspid Regurgitation Severity and Diagnosis
- Significant TR is an independent predictor of reduced event-free and overall survival 3
- Echocardiography allows for a comprehensive assessment of TR severity and mechanisms 3
- A new outcomes-based "massive" grade of TR has been proposed, defined by a vena contracta ≥ 0.92 cm 4
- This "massive" grade of TR is associated with worse survival and greater adverse right ventricular remodeling 4
Management of Tricuspid Regurgitation
- Medical management of TR is generally preferable in patients with fixed pulmonary hypertension and right ventricular dysfunction 3
- Tricuspid annular dilatation should trigger prophylactic tricuspid valve repair in patients undergoing mitral valve surgery, regardless of the degree of TR 3
- Transcatheter TV replacement and repair systems have shown efficacy and safety in treating TR 2, 5
- These transcatheter solutions may provide an effective treatment option for patients not eligible for surgery 2, 5
Tricuspid Valve Imaging and Intervention
- Two- and three-dimensional echocardiography are useful for assessing TR severity and mechanisms 3, 4
- Multi-modality imaging, including echocardiography and other imaging modalities, plays a crucial role in the diagnosis and management of TR 5
- Tricuspid valve abnormalities in congenital heart disease comprise a wide spectrum, with the most common being Ebstein anomaly and tricuspid valve dysplasia 6
- Surgical treatment of tricuspid valve disease remains the mainstay of therapy, although primary catheter-based interventions are uncommon 6