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 pathology requiring intervention. The mitral valve has a normal structure with a peak velocity of 1.2 m/s, no stenosis, and only trivial regurgitation, with a mitral valve area of 3.6 cm² and a mean gradient of 2 mmHg, which are within normal ranges 1. The tricuspid valve also shows normal structure with no stenosis and only trivial regurgitation, with a right atrial pressure of 3 mmHg and an inferior vena cava caliber of 1.3 cm, indicating normal right-sided pressures. The tricuspid regurgitation velocity is 1.2 m/s, suggesting normal right ventricular systolic pressure.

The trivial regurgitation noted in both valves is a common finding even in normal hearts and is not clinically significant, as supported by the guidelines on the management of valvular heart disease 1. According to the 2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM guideline, valvular regurgitation is broadly classified as either primary or secondary, and secondary MR results from diseases that primarily affect the LV or the left atrium, causing impaired function of the MV apparatus 1. However, in this case, there is no indication of significant valvular regurgitation or other pathology requiring intervention.

Key points to consider in this patient's evaluation include:

• Normal mitral and tricuspid valve structure and function
• No significant stenosis or regurgitation
• Normal right-sided pressures
• Trivial regurgitation is a common finding in normal hearts and is not clinically significant
• No specific treatment is needed based on these findings, and routine cardiac follow-up would be appropriate, as there is no evidence to suggest otherwise 1.

From the Research

Mitral Valve and Tricuspid Valve Relationship

• The mitral valve and tricuspid valve are closely related in terms of function, with any pathophysiological condition concerning the mitral valve potentially affecting the tricuspid valve 2.
• Functional tricuspid regurgitation (TR) can develop after surgical mitral valve correction, and is associated with a poorer prognosis in terms of morbidity and mortality 2, 3.

Tricuspid Regurgitation Mechanisms and Risk Factors

• Pressure and volume overload are the underlying pathophysiological mechanisms of TR, with structural alterations such as tricuspid annulus dilatation and right ventricular remodelling often present 2, 4.
• Risk factors for late TR development include elderly age, female gender, larger left atrial size, atrial fibrillation, right chamber dilatation, and higher pulmonary artery systolic pressures 2.

Diagnosis and Treatment of Tricuspid Regurgitation

• Echocardiography, including 3D Echo techniques, is crucial in the early diagnosis and prognosis of future tricuspid valve disease development 2.
• Surgical treatment remains the gold standard for TR, but indication and timing of surgical interventions are debated, and transcatheter therapies are being developed as less invasive options 3, 5.

Prognostic Relevance of Mitral and Tricuspid Regurgitation

• Concomitant mitral regurgitation (MR) and TR are frequently present in patients with aortic stenosis, and are associated with poor outcomes, with timely aortic valve intervention and concomitant mitral valve surgery potentially improving survival 6.
• The presence of significant TR is associated with dismal outcomes, regardless of the treatment strategy 6.