From the Guidelines
The tricuspid valve function appears normal with only physiologic trivial regurgitation, and no intervention is needed as these findings represent normal cardiac hemodynamics. The inferior vena cava (IVC) caliber is 1.3 cm, which is within normal limits, suggesting normal right atrial pressure, as indicated 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. According to the 2014 AHA/ACC guideline for the management of patients with valvular heart disease, these findings are consistent with Stage A, where the patient is at risk of tricuspid regurgitation but has no or trace tricuspid regurgitation and normal valve hemodynamics 1.
Key Findings
- Normal tricuspid valve structure
- Trivial regurgitation
- No stenosis
- IVC caliber: 1.3 cm (within normal limits)
- Right atrial pressure: 3 mmHg (normal)
- Tricuspid regurgitation velocity: 1.2 m/s (low pressure gradient)
Clinical Implications
- The normal IVC size and low right atrial pressure indicate adequate right heart function without evidence of right-sided heart failure or pulmonary hypertension 1.
- The low TR velocity further confirms the absence of elevated right ventricular systolic pressure.
- These parameters should be monitored during routine cardiac follow-up, but currently do not warrant any specific treatment or additional testing, as supported by the guidelines 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
- Functional TR, the most common form of TR, is caused by cardiomyopathies, LV valve disease, or pulmonary disease 3
Diagnosis and Assessment 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
- Severe tricuspid regurgitation is a progressive condition associated with substantial morbidity, poor quality of life, and increased mortality 4
- The optimal timing of referral for isolated tricuspid valve (TV) intervention is undefined, and TV surgery has been associated with elevated risk of morbidity and mortality 4
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
Prognosis and Outcomes
- Significant tricuspid regurgitation 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
- Tricuspid regurgitation is a notable aspect of congestive heart failure and is linked with worse outcomes if untreated 5