From the Guidelines
The tricuspid valve function appears normal with only physiologic (trivial) regurgitation, and no intervention is required as these findings represent normal cardiac hemodynamics. The inferior vena cava (IVC) caliber is 1.3 cm, which is within normal limits, suggesting normal right atrial pressure, as an IVC diameter < 2.1 cm is considered normal 1. 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. According to the 2014 AHA/ACC guideline for the management of patients with valvular heart disease, these findings are consistent with Stage A, at risk of TR, with no or trace TR and normal valve anatomy and hemodynamics 1.
The normal IVC size and low right atrial pressure indicate adequate right heart function without evidence of right-sided heart failure or pulmonary hypertension. The low TR velocity further confirms the absence of elevated right ventricular systolic pressure. Key parameters to assess the severity of TR include the tricuspid valve morphology, color flow TR jet, CW signal of TR jet, vena contracta width, and hepatic vein flow, among others 1. In this case, the trivial regurgitation and normal CW signal of the TR jet suggest mild or no significant TR.
Some important points to consider in the assessment of TR severity include:
- The grading of TR severity based on parameters such as qualitative, semi-quantitative, and quantitative measures 1
- The importance of integrating these parameters with clinical findings to determine the severity of TR 1
- The need for routine cardiac follow-up to monitor these parameters and detect any potential changes or pathological developments. Based on the provided evidence and guidelines, the current findings do not indicate a need for intervention, and monitoring during routine cardiac follow-up is recommended.
From the Research
Tricuspid Valve Structure and Function
- The tricuspid valve is a complex structure that plays a crucial role in maintaining cardiac function 2, 3.
- Tricuspid regurgitation (TR) is a common lesion of the tricuspid valve, with mild TR being common and usually benign, while moderate or severe TR can lead to irreversible myocardial damage and adverse outcomes 3.
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 2.
- Management of TR includes diuretics, ACE inhibitors, and aldosterone antagonists, while surgical annuloplasty or valve replacement should be considered in patients with progressive RV dilatation without severe LV dysfunction and pulmonary hypertension 2.
- Transcatheter repair/replacement is an emerging therapy for high-risk patients with TR who would otherwise have a dismal clinical prognosis 2, 4.
Tricuspid Regurgitation and Right-Sided Heart Failure
- Right-sided heart failure and tricuspid regurgitation are common and strongly associated with poor quality of life and an increased risk of heart failure hospitalizations and death 5.
- Early identification of right heart failure and tricuspid regurgitation may be crucial, and optimal management requires knowledge about the different mechanisms and causes, clinical course and presentation, as well as possible treatment options 5.
Tricuspid Regurgitation in Patients with Heart Failure and Preserved Ejection Fraction
- Heart failure with preserved ejection fraction (HFpEF) is associated with high morbidity and mortality, and tricuspid regurgitation is a distinct phenotype or a marker for advanced HF 6.
- Management of HFpEF may affect the pathophysiology of TR, and the physiologic changes that occur following transcatheter treatment of TR may also impact symptoms and outcomes in patients with HFpEF 6.