From the Guidelines
The tricuspid valve assessment shows normal structure with trivial regurgitation and no stenosis, indicating normal tricuspid valve function without evidence of significant pathology, as supported by the European Association of Cardiovascular Imaging guidelines 1. The inferior vena cava (IVC) caliber is 1.3 cm with greater than 50% respiratory variation, consistent with normal right atrial pressure, which is measured at 3 mmHg.
- Key findings include:
- Normal IVC size with appropriate respiratory collapse, suggesting normal right heart filling pressures
- Trivial regurgitation, a common physiological finding present in many healthy individuals, which does not require intervention
- Low TR velocity of 1.2 m/s, confirming the absence of pulmonary hypertension, as elevated right ventricular systolic pressures would typically result in higher regurgitant velocities According to the 2017 ESC/EACTS guidelines for the management of valvular heart disease, indications for surgery in tricuspid regurgitation are based on the severity of regurgitation, right ventricular function, and symptoms 1.
- However, in this case, the findings do not meet the criteria for surgical intervention, and therefore, no specific treatment or follow-up is necessary for these normal findings, though routine cardiac evaluation may continue as part of standard healthcare maintenance. The American College of Cardiology/American Heart Association task force on practice guidelines also provides a framework for the management of patients with valvular heart disease, including tricuspid regurgitation, emphasizing the importance of integrating clinical findings with imaging parameters to assess disease severity 1.
- In this scenario, the integration of clinical and imaging findings confirms the absence of significant tricuspid valve pathology, supporting the recommendation for routine cardiac evaluation without specific intervention.
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 is the most common form of TR, 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
- The vena contracta (VC) can be measured to assess TR severity, with a VC ≥ 0.7 cm indicating severe functional TR 4
- A VC > 0.92 cm is associated with worse survival and is termed "massive" TR 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
Prognostic Factors and Outcomes
- Significant TR leads to worsening prognosis regardless of the underlying etiology 2
- Elevated right atrial pressure (RAP) and reduced right ventricular free wall longitudinal strain (RVFWLS) are independent predictors of all-cause death in patients with severe functional TR 5
- The combination of elevated RAP and reduced RVFWLS effectively stratifies the risk of all-cause death in patients with severe functional TR 5