What is the significance of a tricuspid valve (TV) area of 3.6 cm² with trivial regurgitation, and a pulmonic valve (PV) peak velocity of 1.0 m/s, in the context of normal cardiac structure and function?

From the Guidelines

The patient's echocardiogram findings indicate normal cardiac valve function with no significant abnormalities, and therefore, no specific interventions are needed based on these normal cardiac findings. The tricuspid valve has normal structure with only trivial regurgitation, and no stenosis. The right atrial area is 3.6 cm², which is within normal limits. The inferior vena cava (IVC) caliber is 1.3 cm, indicating normal right atrial pressure estimated at 3 mmHg. The tricuspid regurgitation velocity is 1.2 m/s, which is not elevated. The pulmonic valve also appears structurally normal with no stenosis and normal regurgitation. The peak velocity across the pulmonic valve is 1.0 m/s with a peak gradient of 4 mmHg and mean gradient of 2 mmHg, all within normal ranges.

According to the 2014 AHA/ACC guideline for the management of patients with valvular heart disease 1, the patient's tricuspid regurgitation is classified as trivial, which corresponds to Stage A, indicating no or trace TR with no symptoms or consequences. The guideline emphasizes the importance of integrating multiple parameters, including valve anatomy, hemodynamics, and clinical findings, to assess the severity of tricuspid regurgitation.

In this case, the patient's normal echocardiogram findings, including trivial tricuspid regurgitation and normal pulmonic valve function, suggest that no further evaluation or intervention is necessary. The European Association of Cardiovascular Imaging consensus statement 1 also highlights the importance of multi-modality imaging in evaluating patients with valvular heart disease, but in this case, the echocardiogram findings are sufficient to guide management.

Key points to consider in this patient's management include:

• Normal tricuspid valve structure and function
• Trivial tricuspid regurgitation
• Normal pulmonic valve function
• No evidence of pulmonary hypertension or significant valvular disease
• No symptoms or consequences related to tricuspid regurgitation.

From the Research

Tricuspid Valve Evaluation

• The tricuspid valve disease evaluation is based on echocardiography, and color flow Doppler is useful for quantifying tricuspid regurgitation 2.
• Tricuspid stenosis can be accurately assessed using mean and end-diastolic pressure gradient measurements 2.
• The treatment options for tricuspid stenosis include balloon valvuloplasty and surgical valve repair 2.
• Functional tricuspid regurgitation associated with left heart disease may require surgical attention during an operation to treat the left heart disease 2.

Pulmonary Valve Evaluation

• Pulmonary valve disease is predominantly congenital, and generally takes the form of pulmonary stenosis 2.
• Pulmonary regurgitation often results from surgical or balloon valvuloplasty and is associated with deleterious long-term sequelae 2.
• Transcatheter pulmonary valve replacement (TPVR) is growing in use and is the procedure of choice in patients with failed bioprostheses via valve-in-valve implantation 3.
• The Melody and SAPIEN XT devices are the currently available TPVR technologies 3.

Treatment Options

• Tricuspid annuloplasty is the preferred technique given its superior long-term outcomes 4.
• Current American and European guidelines advocate for a more proactive surgical approach in the treatment of tricuspid regurgitation and/or annular dilatation at the time of left-sided valve surgery 4.
• Transcatheter therapy is primarily directed toward non-surgical patients and is not included in this review 4.
• Transcatheter tricuspid valve interventions (TTVI) are broadly categorized into direct suture annuloplasty devices, minimally invasive annuloplasty, direct ring annuloplasty devices, coaptation-based strategies, edge-to-edge repair devices, and transcatheter valve replacement 3.

General Health Checks

• General health checks were not associated with reduced mortality or cardiovascular events, but were associated with increased chronic disease recognition and treatment, risk factor control, preventive service uptake, and improved patient-reported outcomes 5.
• Primary care teams may reasonably offer general health checks, especially for groups at high risk of overdue preventive services, uncontrolled risk factors, low self-rated health, or poor connection or inadequate access to primary care 5.