From the Guidelines
The tricuspid valve is normal with no indication for intervention, as all parameters, including trivial regurgitation, normal IVC caliber, and low TR velocity, are within normal limits. The tricuspid valve assessment shows normal structure with trivial regurgitation and no stenosis, which is consistent with Stage A "At risk of TR" as defined by the 2014 AHA/ACC guideline for the management of patients with valvular heart disease 1. The inferior vena cava (IVC) caliber is 1.3 cm, which is within normal limits, suggesting normal right atrial pressure. This is confirmed by the measured right atrial pressure of 3 mmHg, which is also normal. The tricuspid regurgitation velocity is 1.2 m/s, indicating a low pressure gradient across the valve. Based on these findings, the right ventricular systolic pressure (RVSP) is likely normal, as the TR velocity is low. Some key points to consider in this assessment include:
- The absence of significant tricuspid regurgitation or stenosis
- Normal IVC caliber and right atrial pressure
- Low TR velocity, which suggests low right ventricular systolic pressure
- The patient's condition is consistent with Stage A "At risk of TR" as defined by the 2014 AHA/ACC guideline for the management of patients with valvular heart disease 1 According to the 2020 European Heart Journal position statement, pulmonary hypertension is excluded when TR velocity is < 2.8 m/s, and there are no additional echocardiographic variables suggestive of PH present 1. Since the TR velocity is 1.2 m/s, which is well below the threshold, pulmonary hypertension is unlikely. Overall, these findings suggest normal right heart function without evidence of pulmonary hypertension or right-sided heart failure. Regular cardiac follow-up as per standard guidelines is appropriate, but no specific treatment is required for the tricuspid valve based on these echocardiographic findings.
From the Research
Tricuspid Valve Structure and Function
- The tricuspid valve is a complex structure that plays a crucial role in maintaining cardiac function 2, 3, 4.
- Tricuspid regurgitation (TR) is a common lesion of the tricuspid valve, with mild TR being common and usually benign, but moderate or severe TR can lead to irreversible myocardial damage and adverse outcomes 4.
Diagnosis and Treatment of Tricuspid Valve Disease
- Echocardiography can assess the TR etiology/severity, measure RA and RV size and function, estimate pulmonary pressure, and characterize LV disease 2.
- Management of TR includes diuretics, ACE inhibitors, and aldosterone antagonists, with surgical annuloplasty or valve replacement considered in patients with progressive RV dilatation without severe LV dysfunction and pulmonary hypertension 2, 3.
- Transcatheter repair/replacement is an emerging therapy for high-risk patients with TR who would otherwise have a dismal clinical prognosis 2, 3, 5.
Tricuspid Regurgitation Severity and Outcome
- The severity of TR is associated with mortality, and a low use of surgical solutions in the setting of high in-hospital mortality attributed to the late presentation of the disease 5.
- Accurate diagnosis of TR severity is crucial to determine appropriate management solutions, with multi-parametric echocardiographic approach and multi-modality imaging playing a key role 5.
Tricuspid Valve Imaging and Intervention
- Tricuspid valve abnormalities in congenital heart disease comprise a wide spectrum, with the most common being Ebstein anomaly and tricuspid valve dysplasia 6.
- Surgical treatment of tricuspid valve disease remains the mainstay of therapy, with primary catheter-based interventions being uncommon, but tricuspid valve-in-valve catheter-based replacement being a possible option for patients with a bioprosthesis 6.