From the Guidelines
The tricuspid valve function appears normal with no significant pathology requiring intervention, given the trivial regurgitation, normal structure, and low pressure gradient across the valve, as indicated by a tricuspid regurgitation velocity of 1.2 m/s 1. 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. Some key points to consider in this assessment include:
- The tricuspid regurgitation is classified as trivial, which is a common physiological finding in healthy individuals, and does not require specific treatment 1.
- The right ventricular systolic pressure (RVSP) is likely normal given the low TR velocity, though the exact value is not provided.
- The findings suggest normal right heart hemodynamics without evidence of pulmonary hypertension or right ventricular dysfunction.
- Regular cardiac follow-up with routine echocardiography would be appropriate to monitor for any changes over time, using guidelines such as those provided by the European Association of Cardiovascular Imaging 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 present in 1.6 million individuals in the United States and 3.0 million people in Europe 3
- TR can be classified into two basic categories: primary and secondary TR, with secondary TR being more common 4
Diagnosis and Severity Grading of Tricuspid Regurgitation
- Echocardiography can assess the TR etiology/severity, measure RA and RV size and function, estimate pulmonary pressure, and characterize LV disease 3
- A new outcomes-based "massive" grade of TR has been proposed, defined by a vena contracta ≥ 0.92 cm 5
- Multi-parametric echocardiographic approach is recommended for grading TR severity, but has limitations and may underestimate TR severity 6
Management and Treatment of Tricuspid Regurgitation
- Management 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
- Transcatheter tricuspid valve repair/replacement is an emerging therapy for high-risk patients with TR who would otherwise have a dismal clinical prognosis 3, 2