What are the implications of a normal tricuspid valve structure with trivial regurgitation, no stenosis, and a normal right ventricular systolic pressure (RVSP) on cardiac function?

From the Guidelines

The tricuspid valve appears normal and functioning properly, with no indication for intervention based on the provided data and guidelines from the European Society of Cardiology 1. The valve has a normal structure with good leaflet mobility, showing respiratory variation greater than 50% which is physiologically appropriate.

• Key findings include:
  • Trivial tricuspid regurgitation with a low velocity of 1.2 m/s, indicating minimal backward flow.
  • No tricuspid stenosis is present.
  • The inferior vena cava (IVC) diameter is normal at 1.3 cm.
  • The right atrial pressure is estimated at 3 mmHg, which is within normal limits. These findings collectively indicate a healthy, well-functioning tricuspid valve with normal right-sided cardiac pressures.
• According to the 2017 ESC/EACTS guidelines for the management of valvular heart disease 1, intervention is not recommended for trivial tricuspid regurgitation without symptoms or signs of right heart dysfunction. The trivial regurgitation noted is considered a normal variant found in many healthy individuals and does not require any intervention or follow-up.
• The normal IVC size and low right atrial pressure further confirm the absence of right heart dysfunction or elevated right-sided pressures, supporting the decision for no intervention 1.

From the Research

Tricuspid Valve Structure and Function

• The tricuspid valve is a complex structure consisting of three leaflets (anterior, posterior, and septal) inserted in the fibrous tricuspid annulus and connected to the papillary muscle via the chordae tendinae 2.
• The normal tricuspid valve anatomy is essential to understanding the pathophysiology of tricuspid regurgitation 3.

Tricuspid Regurgitation Diagnosis and Treatment

• Tricuspid regurgitation is present in 1.6 million individuals in the United States and 3.0 million people in Europe, with functional TR being the most common form 4.
• Echocardiography can assess the TR etiology/severity, measure RA and RV size and function, estimate pulmonary pressure, and characterize LV disease 4.
• Management of tricuspid regurgitation includes diuretics, ACE inhibitors, and aldosterone antagonists, with surgical annuloplasty or valve replacement considered in patients with progressive RV dilatation without severe LV dysfunction and pulmonary hypertension 4.
• Transcatheter repair/replacement is an emerging therapy for high-risk patients with TR who would otherwise have a dismal clinical prognosis 4, 5, 6.

Tricuspid Regurgitation Severity and Treatment Options

• The five-year survival with severe TR and HFrEF is 34% 4.
• 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 5.
• Novel transcatheter therapies have begun to emerge for the treatment of tricuspid regurgitation in patients deemed at very high or prohibitive surgical risk 5, 6.
• Recent advances in surgical techniques and transcatheter therapy, particularly edge-to-edge repair devices, have demonstrated promising results for safety, reduction in tricuspid regurgitation, and improving quality of life 6.