What is the diagnosis for a patient with a tricuspid valve (TV) showing trivial regurgitation, normal structure, and a tricuspid regurgitation (TR) velocity of 1.2 meters per second (m/s)?

From the Guidelines

The tricuspid valve is normal with trivial regurgitation, and no intervention is needed as all parameters are within normal limits. The inferior vena cava (IVC) caliber is 1.3 cm, which is within normal limits, suggesting normal right atrial pressure, as supported by the European Society of Cardiology guidelines on valvular heart disease 1. 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.

Key Findings:

• Normal tricuspid valve structure
• Trivial regurgitation, which is a common finding even in healthy individuals and is not clinically significant, as stated in the 2014 AHA/ACC guideline for the management of patients with valvular heart disease 1
• Normal IVC size (1.3 cm)
• Normal right atrial pressure (3 mmHg)
• Low tricuspid regurgitation velocity (1.2 m/s)

Clinical Implications:

• No right-sided heart dysfunction is present, given the normal IVC size and right atrial pressure
• 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, in line with the guidelines from the American College of Cardiology/American Heart Association task force on practice guidelines 1
• The patient's condition corresponds to Stage A (at risk of TR) according to the 2014 AHA/ACC guideline, where no intervention is necessary for trivial TR with normal valve anatomy and hemodynamics 1

From the Research

Tricuspid Valve Structure and Function

• The tricuspid valve is a complex structure that can be affected by various diseases, including tricuspid regurgitation and stenosis 2.
• Tricuspid regurgitation is frequently encountered and is most often secondary in nature, caused by annular dilatation and leaflet tethering from adverse right ventricular remodelling 2.
• The assessment of tricuspid valve disease requires non-invasive imaging modalities, such as echocardiography, MRI, and CT, to define the cause and severity of the disease 2, 3, 4.

Diagnosis and Treatment of Tricuspid Valve Disease

• The diagnosis of tricuspid valve disease involves the use of advanced imaging modalities, including 3-dimensional echocardiography, to visualize the valve anatomy and define the mechanism of regurgitation 3, 4.
• The treatment of tricuspid regurgitation depends on the cause and severity of the disease, as well as the patient's overall health status 2.
• Surgical repair or replacement of the tricuspid valve may be necessary in some cases, while transcatheter therapies are emerging as a treatment option for patients with severe tricuspid regurgitation who are at high surgical risk 2, 3.

Echocardiographic Assessment of the Tricuspid Valve

• Echocardiography is the first-line imaging modality for the assessment of right-sided valve disease, including tricuspid regurgitation 4.
• The principle objectives of the echocardiographic study are to determine the aetiology, mechanism, and severity of valvular dysfunction, as well as the consequences on right heart remodelling and estimations of pulmonary artery pressure 4.
• Three-dimensional echocardiography is a pivotal tool for accurate quantification of right ventricular volumes and regurgitant lesion severity, anatomical characterisation of valve morphology, and remodelling pattern, and procedural guidance for catheter-based interventions 3, 4.