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 valve is made up of many different closely linked structures: the annulus, the three leaflets, the chordae, the papillary muscles, and the right ventricle 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.
- Annulus dilation and leaflet tethering due to right ventricular remodeling are the 2 major mechanisms responsible for most tricuspid regurgitation cases 3.
Diagnosis and Treatment
- 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, 5.
- Novel transcatheter therapies have begun to emerge for the treatment of tricuspid regurgitation in patients who are deemed at very high or prohibitive surgical risk 5, 6.
Imaging and Treatment Options
- Advanced cardiac imaging, including transthoracic echocardiography, transesophageal echocardiography, cardiac computed tomography, and cardiac magnetic resonance imaging, is often required to best visualize the pathology 6.
- The choice of transcatheter treatment options for patients with tricuspid valve disease depends on the individual patient's anatomy and pathology 6.