What is the diagnosis for a patient with a normal mitral valve structure, trivial mitral regurgitation, and trivial tricuspid regurgitation, with no stenosis in either valve?

From the Guidelines

The patient's echocardiographic findings indicate normal mitral and tricuspid valve function, with no significant valvular disease requiring intervention or follow-up. The mitral valve has a normal structure with a peak velocity of 1.2 m/s, a peak gradient of 6 mmHg, and a mean gradient of 2 mmHg. The mitral valve area is 3.6 cm², which is within normal limits, and there is only trivial regurgitation with no stenosis. The tricuspid valve also appears normal with trivial regurgitation, no stenosis, and normal respiratory variation. The inferior vena cava (IVC) caliber is 1.3 cm, which is normal, suggesting normal right atrial pressure estimated at 3 mmHg. The tricuspid regurgitation velocity is 1.2 m/s, indicating normal right ventricular systolic pressure. Some key points to consider in the management of valvular heart disease include:

• Trivial tricuspid regurgitation is frequently detected by echocardiography in normal subjects, as noted in the guidelines on the management of valvular heart disease 1.
• The etiology, severity, and hemodynamic consequences of valvular regurgitation should be understood before any non-cardiac surgery, as stated in the 2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM guideline for perioperative cardiovascular management for noncardiac surgery 1. Overall, these findings represent normal cardiac valve function with no significant valvular disease requiring intervention or follow-up. The trivial regurgitation noted in both valves is a common finding even in healthy individuals and is not clinically significant.

From the Research

Mitral Valve and Tricuspid Valve Structure and Function

• The mitral valve is a dynamic structure that permits blood to flow from the left atrial to left ventricle during diastole and sealing of the left atrial from the left ventricle during systole 2
• The tricuspid valve is inseparably connected with the mitral valve in terms of function, and any pathophysiological condition concerning the mitral valve is potentially a threat for the normal function of the tricuspid valve as well 3

Tricuspid Regurgitation in Mitral Valve Disease

• Tricuspid regurgitation (TR) in patients with mitral valve (MV) disease is associated with poor outcome and predicts poor survival, heart failure, and reduced functional capacity 4
• Functional tricuspid regurgitation is a common finding in patients with left-sided heart disease, and if left untreated, it may reduce survival, limit functional capacity, and cause end-organ dysfunction 5
• The time of TR manifestation can be up to 10 years or more after an MV surgery 3

Prognostic Implications and Management

• The presence of mitral regurgitation (MR) in patients with severe aortic stenosis characterizes a high-risk population, and timely aortic valve intervention confers a survival benefit 6
• Concomitant mitral valve surgery should be considered according to operative risk, and the additional presence of significant tricuspid regurgitation is associated with dismal outcomes, regardless of the treatment strategy 6
• Tricuspid annuloplasty with a ring should be performed at the initial MV surgery, and the tricuspid annulus diameter (>or=3.5 cm) is the best criterion for performing the annuloplasty 4