What is the significance of trivial tricuspid regurgitation (TR) with a tricuspid valve (TV) velocity of 1.2 meters per second (m/s) and right ventricular systolic pressure (RVSP) in the context of a normal tricuspid valve structure and mildly elevated inferior vena cava (IVC) caliber?

From the Guidelines

The tricuspid valve assessment shows normal structure with no stenosis and only trivial regurgitation, indicating no need for specific treatment or intervention, as supported by the most recent guidelines 1. The inferior vena cava (IVC) caliber is 1.3 cm with greater than 50% respiratory variation, and the right atrial pressure is estimated at 3 mmHg, which are within normal limits. The tricuspid regurgitation velocity is 1.2 m/s, further supporting the absence of elevated right ventricular systolic pressure. Some key points to consider in the evaluation of tricuspid regurgitation include:

• The presence of trivial tricuspid regurgitation, which is a common physiologic finding that requires no intervention, as stated in the European Society of Cardiology guidelines 1.
• The importance of evaluating right ventricular function and dimensions, as well as pulmonary arterial systolic pressure, in patients with more than mild tricuspid regurgitation, as recommended by the European Association of Cardiovascular Imaging 1.
• The role of transcatheter tricuspid valve intervention (TTVI) in selected symptomatic patients with severe functional tricuspid regurgitation and refractory right-sided heart failure, as discussed in the 2022 systematic review of clinical practice guidelines and recommendations 1. However, in this case, the findings indicate normal right heart hemodynamics with no evidence of pulmonary hypertension or right ventricular dysfunction, and therefore, no specific treatment is needed, and regular cardiac follow-up can continue as previously scheduled, with no additional testing or intervention required based on these tricuspid valve parameters 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
• The tricuspid valve apparatus consists of 3 leaflets (anterior, posterior, and septal) inserted in the fibrous tricuspid annulus and connected to the papillary muscle via the chordae tendinae 3

Tricuspid Regurgitation

• Tricuspid regurgitation (TR) is present in 1.6 million individuals in the United States and 3.0 million people in Europe 4
• Functional TR, the most common form of TR, is caused by cardiomyopathies, LV valve disease, or pulmonary disease 4
• TR is functional and is a satellite of left-sided heart disease and/or elevated pulmonary artery pressure most of the time 5

Diagnosis and Treatment of Tricuspid Regurgitation

• Echocardiography can assess the TR etiology/severity, measure RA and RV size and function, estimate pulmonary pressure, and characterize LV disease 4
• Management includes diuretics, ACE inhibitors, and aldosterone antagonists 4
• Surgical annuloplasty or valve replacement should be considered in patients with progressive RV dilatation without severe LV dysfunction and pulmonary hypertension 4
• Transcatheter repair/replacement is possible in patients with a LVEF <40%, dilated annuli, and impaired RV function 4

Imaging and Analysis of Tricuspid Regurgitation

• Three-dimensional imaging, cardiac magnetic resonance imaging, and computed tomography scans may add to two-dimensional transthoracic and transoesophageal echocardiographic data in the analysis of TR 5
• Multimodality imaging should help with the appropriate selection of patients who will benefit from either surgical TV repair/replacement or a percutaneous procedure for TR 5