From the Guidelines
The patient's echocardiographic findings indicate normal mitral and tricuspid valve function, and no intervention is required. The mitral valve has a normal structure with a peak velocity of 1.2 m/s, peak gradient of 6 mmHg, and a calculated valve area of 3.6 cm², which is well within normal limits 1. There is only trivial mitral regurgitation, which is physiologic and not clinically significant. The tricuspid valve also appears structurally normal with trivial regurgitation, as frequently detected in normal subjects 1. Key points about the tricuspid valve include:
- Normal structure
- Trivial regurgitation
- Normal inferior vena cava (IVC) caliber of 1.3 cm, suggesting normal right atrial pressure
- Estimated right atrial pressure of 3 mmHg
- Tricuspid regurgitation velocity of 1.2 m/s, indicating normal right ventricular systolic pressure These findings collectively indicate healthy valve function without evidence of stenosis or significant regurgitation in either the mitral or tricuspid valves. As stated in the guidelines on the management of valvular heart disease 1, pathological tricuspid regurgitation is more often functional rather than due to a primary valve lesion, but in this case, the trivial regurgitation is not indicative of any underlying pathology. Therefore, routine cardiac follow-up can be continued as per the patient's baseline risk factors, without the need for any specific intervention for the valve function.
From the Research
Mitral Valve Assessment
- The mitral valve structure is reported as normal with a peak velocity of 1.2 m/s, indicating no stenosis 2.
- The mean pressure gradient is 6 mmHg, and the mitral valve area (MVA) is 3.6 cm², which is within the normal range 2.
- Trivial regurgitation is noted, which is a common finding in patients with normally functioning prosthetic valves 2.
Tricuspid Valve Assessment
- The tricuspid valve structure is reported as normal with no stenosis, and trivial regurgitation is noted 3, 4.
- The peak velocity is 1.2 m/s, which is similar to the mitral valve peak velocity 2.
- The presence of tricuspid regurgitation (TR) in patients with mitral valve disease is associated with poor outcome and predicts poor survival, heart failure, and reduced functional capacity 3.
Clinical Implications
- The presence of mitral regurgitation (MR) and tricuspid regurgitation (TR) in patients with severe aortic stenosis is associated with poor outcomes, and timely aortic valve intervention confers a survival benefit 5.
- Concomitant mitral valve surgery should be considered according to operative risk, and the additional presence of significant TR is associated with dismal outcomes, regardless of the treatment strategy 5.
- Transcatheter therapies for mitral and tricuspid valve require a more tailored approach than for the aortic valve, because of more heterogeneous clinical scenarios, anatomic features, and mechanisms of valvular lesions 6.