From the Guidelines
The tricuspid valve is functioning normally with only trivial regurgitation and no evidence of stenosis, and therefore, no intervention is needed at this time. The inferior vena cava (IVC) diameter 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 within normal range. 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. According to the 2014 AHA/ACC guideline for the management of patients with valvular heart disease, trivial tricuspid regurgitation is considered a normal variant rather than pathological, and is commonly found in healthy individuals 1.
Some key points to consider in this case include:
- The absence of significant tricuspid regurgitation or stenosis
- Normal IVC diameter and right atrial pressure
- Low tricuspid regurgitation velocity, indicating a low pressure gradient across the valve
- The patient's tricuspid valve function is consistent with stage A, "at risk of TR", according to the 2014 AHA/ACC guideline, which indicates no significant valve disease or hemodynamic abnormalities 1. Regular cardiac follow-up with routine echocardiography would be appropriate to monitor for any changes in valve function over time, but no specific treatment is indicated based on these findings.
From the Research
Tricuspid Valve Structure and Function
- The tricuspid valve is a complex anatomical structure that incorporates a saddle-shaped annulus, asymmetric leaflets, the subvalvular apparatus, and the right ventricle and its loading conditions 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 in response to various disease processes 3
Tricuspid Regurgitation Assessment and Treatment
- Non-invasive assessment of tricuspid regurgitation must define its cause and severity, using advanced three-dimensional echocardiography, MRI, and CT 3
- The indications for tricuspid valve surgery to treat tricuspid regurgitation are related to the cause of the disorder, the context in which it is encountered, its severity, and its effects on right ventricular function 3
- Novel transcatheter therapies have begun to emerge for the treatment of tricuspid regurgitation in patients deemed at high or prohibitive surgical risk 3, 4, 5
Echocardiographic Evaluation of Tricuspid Valve Disease
- Two and three-dimensional echocardiographic imaging of the tricuspid valve using transthoracic and transesophageal windows are crucial for assessing tricuspid valve disease 2
- Echocardiographic variables measured include mean TV gradient, TV inflow gradient, TV pressure halftime, and TV:left ventricular outflow tract Doppler velocity index 6
- Multimodality imaging has a crucial role in patient selection for transcatheter tricuspid valve intervention, procedure planning, guiding and monitoring the procedure, and assessing and following over time the results of the procedure 4
Tricuspid Valve Intervention and Replacement
- Transcatheter tricuspid valve-in-valve replacement is an emerging therapy for dysfunctional surgical valves in patients with congenital and acquired TV disease 6
- Transcatheter tricuspid valve intervention can be categorized into direct or indirect tricuspid restrictive annuloplasty, direct or indirect restoration of leaflet coaptation, heterotopic tricuspid valve implantation, and transcatheter tricuspid valve replacement 4