From the Guidelines
The tricuspid valve assessment shows normal structure with trivial regurgitation and no stenosis, and based on the latest guidelines from the European Association of Cardiovascular Imaging 1, no intervention is needed for the tricuspid valve 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. 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 the assessment of tricuspid regurgitation include:
- The grading of TR severity, which can be done using parameters such as colour flow TR jet, CW signal of TR jet, and semi-quantitative and quantitative measures 1
- The stages of TR, which include at risk, progressive, asymptomatic severe, and symptomatic severe TR, as outlined in the 2014 AHA/ACC guideline for the management of patients with valvular heart disease 1 However, in this case, the trivial regurgitation is a common finding even in healthy individuals and is not clinically significant. The normal IVC size and right atrial pressure further support that there is no right-sided heart dysfunction or pulmonary hypertension. Regular cardiac follow-up can continue as scheduled, 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 with a broad anatomical variability 2
- Functional tricuspid regurgitation (TR) is a multifactorial disorder, resulting from maladaptive right ventricular remodeling secondary to pulmonary hypertension or from atrial fibrillation leading to dilation of the right atrium, tricuspid annulus, and base of the right ventricle, with pathological TV coaptation 2
Tricuspid Regurgitation Diagnosis and Management
- Significant TR is a common finding, affecting about one in twenty-five subjects among the elderly and presenting more frequently in women than in men 2
- The treatment of TR in patients undergoing left-sided cardiac surgery is well established, but isolated surgical repair of TR is rarely performed due to prohibitive risk 2
- Transcatheter TV replacement and repair systems have shown efficacy and safety when used on the TV, providing an effective treatment option for patients not eligible for surgery 2
- Atrial functional tricuspid regurgitation (AFTR) is a condition distinguished from ventricular functional tricuspid regurgitation by its unique pathophysiological mechanisms and clinical implications 3
Monitoring and Follow-up
- Monitoring severely ill patients is crucial, but it is more important to monitor sick patients with normal vital signs to detect any deterioration as early as possible 4
- Patients with TR should be monitored regularly to assess disease severity and guide treatment decisions, using diagnostic tools such as echocardiography, cardiac magnetic resonance (CMR) imaging, and computed tomography (CT) 3
Pathophysiology and Treatment Options
- Functional TR appears frequently in the presence of left-sided heart valve diseases, combined with symptoms of heart failure, worsens if left untreated, and is associated with poor patient survival 5
- Tricuspid valve annuloplasty is the most adopted surgical option today, but the ideal annuloplasty device remains elusive, and further investigations are needed to address these issues 5
- AFTR is associated with advanced age and right atrial enlargement, and TV deformations and their association with right heart remodeling differ between AFTR and left-sided heart disease-TR 6