What is the significance of trivial tricuspid regurgitation (TR) with a tricuspid valve (TV) velocity of 1.2 meters per second (m/s) and right ventricular systolic pressure (RVSP) in the context of a normal tricuspid valve structure and mildly elevated inferior vena cava (IVC) caliber?

From the Guidelines

The tricuspid valve assessment shows normal structure with no stenosis and only trivial regurgitation, indicating no need for intervention based on these findings, as they represent normal cardiac physiology. The inferior vena cava (IVC) caliber is 1.3 cm with greater than 50% respiratory variation, and the right atrial pressure is estimated at 3 mmHg. The tricuspid regurgitation velocity is 1.2 m/s. These findings indicate normal right heart pressures and tricuspid valve function. The normal IVC size with good respiratory collapse suggests normal right atrial filling pressures. The trivial tricuspid regurgitation is a common finding in healthy individuals and is not clinically significant, as noted in the guidelines on the management of valvular heart disease 1. The low TR velocity of 1.2 m/s confirms the absence of pulmonary hypertension, as higher velocities would suggest increased right ventricular systolic pressure.

Key Findings

• Normal tricuspid valve structure with no stenosis
• Trivial tricuspid regurgitation, which is a common finding in healthy individuals 1
• Normal IVC size with good respiratory collapse, suggesting normal right atrial filling pressures
• Low TR velocity of 1.2 m/s, indicating no pulmonary hypertension

Management

Based on the most recent guidelines, no intervention is needed for the tricuspid valve based on these findings. Regular cardiac follow-up can continue as previously scheduled, with no specific changes needed to management based on these tricuspid valve parameters. This approach is supported by the 2021 study on the advantages, pitfalls, and limitations of guideline-directed medical therapy in patients with valvular heart disease, which highlights the importance of appropriate management of tricuspid regurgitation to improve outcomes 1. However, in this case, the trivial regurgitation and normal valve function do not require intervention. The 2017 ESC/EACTS guidelines for the management of valvular heart disease also provide guidance on indications for surgery in tricuspid regurgitation, but these do not apply to this case with trivial regurgitation and normal valve function 1.

From the Research

Tricuspid Valve Structure and Function

• The tricuspid valve is a complex anatomical structure that incorporates a saddle-shaped annulus, asymmetric leaflets, the subvalvular apparatus, and the right ventricle and its loading conditions 2
• Tricuspid regurgitation (TR) is present in 1.6 million individuals in the United States and 3.0 million people in Europe, with functional TR being the most common form of TR 3

Tricuspid Regurgitation Diagnosis and Treatment

• Echocardiography can assess the TR etiology/severity, measure RA and RV size and function, estimate pulmonary pressure, and characterize LV disease 3
• Management of TR includes diuretics, ACE inhibitors, and aldosterone antagonists, with surgical annuloplasty or valve replacement 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 techniques have evolved, lowering the risk of intervention, and allowing for safer valve repair or replacement 4

Tricuspid Regurgitation Epidemiology and Pathophysiology

• Significant TR is a common finding, affecting about one in twenty-five subjects among the elderly, and presenting more frequently in women than in men 5
• TR can be distinguished as primary and secondary or functional TR (FTR), with FTR being the most prevalent 5
• FTR is a multifactorial disorder, resulting from maladaptive right ventricular remodeling secondary to pulmonary hypertension or from atrial fibrillation leading to dilation of the right atrium, tricuspid annulus, and base of the right ventricle, with pathological TV coaptation 5

Future Perspectives on Tricuspid Valve Disease

• The assessment and management of tricuspid valve disease have evolved substantially during the past several years, with novel transcatheter therapies emerging for the treatment of TR in patients deemed at very high or prohibitive surgical risk 6
• Advanced three-dimensional echocardiography, MRI, and CT are gaining in clinical application for the non-invasive assessment of tricuspid regurgitation 6
• The indications for tricuspid valve surgery to treat tricuspid regurgitation are related to the cause of the disorder, the context in which it is encountered, its severity, and its effects on right ventricular function 6