From the Guidelines
The tricuspid valve function appears normal with no significant pathology, and no intervention is required as the findings represent normal cardiac hemodynamics, according to the most recent guidelines 1. The tricuspid valve assessment shows normal structure with trivial regurgitation and no stenosis.
- The inferior vena cava (IVC) caliber is 1.3 cm, which is within normal limits, suggesting normal right atrial pressure.
- The measured right atrial pressure of 3 mmHg 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 tricuspid valve function 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 right ventricular systolic pressure (RVSP) cannot be precisely calculated from the provided information, but the low TR velocity suggests normal pulmonary pressures. The trivial regurgitation is a common physiological finding present in many healthy individuals and does not indicate valve dysfunction or require treatment, as stated in the guidelines on the management of valvular heart disease by the European Society of Cardiology 1. Therefore, no intervention is required for the tricuspid valve, and monitoring of the patient's condition is sufficient, based on the current evidence 1.
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