What is the diagnosis for a patient with a normal tricuspid valve structure, trivial tricuspid regurgitation, and no stenosis, as well as a normal pulmonic valve structure with no stenosis?

From the Guidelines

The echocardiogram findings indicate normal tricuspid and pulmonic valves with no significant abnormalities, and therefore, no intervention is required. The tricuspid valve has trivial regurgitation, which is a common and benign finding in healthy individuals, as noted in the guidelines on the management of valvular heart disease by the European Society of Cardiology 1. The inferior vena cava (IVC) diameter is 1.3 cm, indicating normal right atrial pressure, confirmed by the measured right atrial pressure of 3 mmHg, which is within normal limits. The tricuspid regurgitation velocity is 1.2 m/s, suggesting normal right ventricular systolic pressure.

Some key points to consider in this case include:

• The absence of significant tricuspid regurgitation or stenosis, as evidenced by the trivial regurgitation and normal gradient across the valve
• The normal structure and function of the pulmonic valve, with a peak velocity of 1.0 m/s and mean velocity of 0.8 m/s, indicating no significant stenosis or obstruction
• The normal right atrial pressure and IVC diameter, which suggest normal right heart hemodynamics

The guidelines on the management of valvular heart disease 1 support the notion that trivial tricuspid regurgitation is frequently detected in normal subjects and is not indicative of pathological disease. Therefore, based on these findings, no further evaluation or intervention is necessary, as the results represent normal cardiac function of the right-sided heart valves.

From the Research

Tricuspid Valve Evaluation

• The tricuspid valve structure is reported as normal, with trivial regurgitation and a TR velocity of 1.2 m/s 2, 3.
• The TR gradient is >50%, indicating potential tricuspid regurgitation severity 3.
• The IVC calibre is 1.3 cm, and the RVSP is not specified, which could be relevant in assessing right heart function 4, 5.
• RA pressure is 3mmHg, which is within normal limits 6.

Pulmonic Valve Evaluation

• The pulmonic valve structure is reported as normal, with no stenosis and a peak velocity of 1.0 m/s 6.
• The peak gradient is 4 mmHg, and the mean gradient is 2 mmHg, indicating no significant pulmonic stenosis 5, 6.
• The mean velocity is 0.8 m/s, which is within normal limits 5.

Clinical Implications

• Tricuspid regurgitation is a common condition, affecting 1.6 million individuals in the United States and 3.0 million people in Europe 2.
• Functional tricuspid regurgitation is often caused by cardiomyopathies, LV valve disease, or pulmonary disease 2.
• Echocardiography is a crucial tool in assessing tricuspid regurgitation severity and guiding management decisions 3, 5.
• Transcatheter tricuspid valve repair or replacement is an emerging therapy for high-risk patients with tricuspid regurgitation 2, 4.