What is the diagnosis for a patient with a normal tricuspid valve (tricuspid valve) structure, trivial tricuspid regurgitation (TR), and no stenosis, as well as a normal pulmonic valve structure with no stenosis or regurgitation?

From the Guidelines

The patient's echocardiogram findings indicate normal tricuspid and pulmonic valve structures with no significant abnormalities, and therefore, no intervention is required. The tricuspid valve has trivial regurgitation, which is a common and benign finding in healthy individuals 1. The inferior vena cava (IVC) diameter is 1.3 cm, indicating normal right atrial pressure, which is confirmed by the measured right atrial pressure of 3 mmHg (normal range is 1-5 mmHg). The tricuspid regurgitation velocity is 1.2 m/s, which is within normal limits and suggests normal right ventricular systolic pressure. Some key points to consider in the management of valvular heart disease include:

• Severe TR in a patient undergoing left-sided valve surgery is an indication for intervention, according to the European Society of Cardiology guidelines 1.
• The American College of Cardiology/American Heart Association task force on practice guidelines provides a staging system for TR, which includes stages A, B, C, and D, depending on the severity of the disease and the presence of symptoms 1. The pulmonic valve shows normal flow with a peak velocity of 1.0 m/s and a peak gradient of 4 mmHg, with mean values of 0.8 m/s and 2 mmHg respectively. These measurements are all within normal physiological ranges and indicate normal right heart hemodynamics with no evidence of pulmonary hypertension, tricuspid stenosis, or significant pulmonic valve disease. Key considerations in the evaluation of TR include:
• Valve anatomy and hemodynamics
• Consequences of the disease, such as right ventricular dilation or dysfunction
• Symptoms, such as fatigue, palpitations, or dyspnea
• The need for intervention, such as surgery or percutaneous repair, depending on the severity of the disease and the presence of symptoms 1.

From the Research

Tricuspid Valve Assessment

• The tricuspid valve structure is reported as normal with trivial regurgitation and a TR velocity of 1.2 m/s 2, 3.
• The TR gradient is >50%, indicating potential tricuspid regurgitation, but the provided velocity and gradient values do not exceed the normal range 4.
• The IVC calibre is 1.3 cm, and the RVSP is not explicitly stated, but the RA pressure is 3mmHg, which is within normal limits.

Pulmonic Valve Evaluation

• The pulmonic valve structure is normal with no stenosis or regurgitation 2, 3.
• The peak velocity is 1.0 m/s, and the peak gradient is 4 mmHg, which are within normal ranges 4.
• The mean velocity and mean gradient are 0.8 m/s and 2 mmHg, respectively, also indicating no significant pulmonic valve disease.

Clinical Implications

• Tricuspid regurgitation can be classified into primary and secondary types, with secondary TR being more common and often caused by tricuspid annular dilatation, right heart failure, and/or pulmonary hypertension 3.
• Echocardiography is essential for assessing TR severity and mechanisms, as well as estimating pulmonary pressure and characterizing LV disease 2, 3.
• The management of TR includes medical treatment with diuretics, ACE inhibitors, and aldosterone antagonists, as well as surgical or transcatheter interventions in selected cases 2, 3.