What is the diagnosis for a patient with a normal mitral valve structure, no stenosis, trivial regurgitation, and a mean pressure gradient of 6 mmHg, and a normal tricuspid valve structure with no stenosis and trivial regurgitation?

From the Guidelines

The patient's echocardiographic findings indicate normal mitral and tricuspid valve function, with no significant abnormalities that would require intervention, as the trivial regurgitation noted in both valves is considered a normal variant found in many healthy individuals 1. The mitral valve has a normal structure with a peak velocity of 1.2 m/s, a peak gradient of 6 mmHg, and a mean gradient of 2 mmHg, which are all within normal limits. The mitral valve area is 3.6 cm², which is slightly below the typical normal range of 4-6 cm², but still considered normal. There is only trivial regurgitation with no stenosis, which is a common finding in healthy individuals. Some key points to consider include:

• The tricuspid valve also appears normal with trivial regurgitation and no stenosis, which is consistent with the findings of 1.
• The inferior vena cava (IVC) caliber is 1.3 cm, which is normal, suggesting normal right atrial pressure estimated at 3 mmHg.
• The tricuspid regurgitation velocity is 1.2 m/s, which indicates normal right ventricular systolic pressure, as stated in 1. These findings collectively indicate healthy valve function with no significant abnormalities that would require intervention. Key considerations for management include:
• Clinical correlation and judgment must accompany the echocardiographic results, as stated in 1.
• Systolic pulmonary artery pressures greater than 55 mm Hg are likely to cause TR with anatomically normal tricuspid valves, whereas TR occurring with systolic pulmonary artery pressures less than 40 mm Hg is likely to reflect a structural abnormality of the valve apparatus, as noted in 1.

From the Research

Mitral Valve and Tricuspid Valve Structure and Function

• The mitral valve is a dynamic structure that permits blood to flow from the left atrial to left ventricle during diastole and sealing of the left atrial from the left ventricle during systole 2
• The tricuspid valve is inseparably connected with the mitral valve in terms of function, and any pathophysiological condition concerning the mitral valve is potentially a threat for the normal function of the tricuspid valve as well 3

Tricuspid Regurgitation in Mitral Valve Disease

• Tricuspid regurgitation (TR) in patients with mitral valve (MV) disease is associated with poor outcome and predicts poor survival, heart failure, and reduced functional capacity 4
• Functional tricuspid regurgitation is a common finding in patients with left-sided heart disease, and if left untreated, it may reduce survival, limit functional capacity, and cause end-organ dysfunction 5
• The time of TR manifestation can be up to 10 years or more after an MV surgery 3

Prognostic Implications and Management

• The presence of mitral regurgitation (MR) in patients with severe aortic stenosis characterizes a high-risk population, and timely aortic valve intervention confers a survival benefit 6
• Concomitant mitral valve surgery should be considered according to operative risk, and the additional presence of significant tricuspid regurgitation is associated with dismal outcomes, regardless of the treatment strategy 6
• Tricuspid annuloplasty with a ring should be performed at the initial MV surgery, and the tricuspid annulus diameter (>or=3.5 cm) is the best criterion for performing the annuloplasty 4