From the Guidelines
The tricuspid valve assessment shows normal structure with trivial regurgitation and no stenosis, and based on the current evidence, no intervention is needed for the tricuspid valve 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 during regurgitation. Based on these findings, the right ventricular systolic pressure (RVSP) is likely normal, as the TR velocity is low.
- Key findings include:
- Normal tricuspid valve structure
- Trivial regurgitation, which 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
- No stenosis
- Normal IVC caliber and right atrial pressure
- Low tricuspid regurgitation velocity
- The current assessment suggests normal right heart function without evidence of pulmonary hypertension or right-sided heart failure.
- Regular cardiac follow-up with routine echocardiography is appropriate to monitor for any changes over time, but no specific treatment is indicated for the tricuspid valve based on the current assessment, as the parameters are within normal limits and the trivial regurgitation is not clinically significant 1.
From the Research
Tricuspid Valve Structure and Function
- The tricuspid valve is a complex structure with a broad anatomical variability 2
- Tricuspid regurgitation (TR) is a common finding, affecting about one in twenty-five subjects among the elderly, and presents more frequently in women than in men 2
- Functional TR is the most common form of TR, caused by cardiomyopathies, LV valve disease, or pulmonary disease 3
Tricuspid Regurgitation Diagnosis and Severity
- Echocardiography can assess the TR etiology/severity, measure RA and RV size and function, estimate pulmonary pressure, and characterize LV disease 3
- Current echocardiographic guidelines recommend that TR severity be graded in three categories, following assessment of specific parameters 4
- A new outcomes-based "massive" grade of TR has been proposed, with a vena contracta (VC) cutoff value of >0.92 cm associated with worse survival 4
Tricuspid Regurgitation Treatment and Management
- Management of TR includes diuretics, ACE inhibitors, and aldosterone antagonists 3
- Surgical annuloplasty or valve replacement should be considered in patients with progressive RV dilatation without severe LV dysfunction and pulmonary hypertension 3
- Transcatheter repair/replacement is possible in patients with a LVEF <40%, dilated annuli, and impaired RV function 3, 5, 2
- Transcatheter TV replacement and repair systems have shown efficacy and safety when used on the TV, providing an effective treatment option for patients not eligible for surgery 2
Tricuspid Regurgitation Prognosis and Outcome
- Significant TR leads to worsening prognosis regardless of the underlying etiology and should be addressed as a separate therapeutic target 2
- The five-year survival with severe TR and HFrEF is 34% 3
- Early diagnosis and mechanical correction of TR is essential in impacting on the natural history of this valvular condition 5