From the Guidelines
The tricuspid valve function appears normal with no significant pathology, and no intervention is needed at this time. The tricuspid valve assessment shows normal structure with trivial regurgitation and no stenosis. 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. Based on the grading of TR severity from the European Association of Cardiovascular Imaging 1, the parameters provided do not indicate significant tricuspid regurgitation. The right ventricular systolic pressure (RVSP) is likely normal, as calculated from the TR velocity using the modified Bernoulli equation (4v²) plus the right atrial pressure. Some key points to consider in the assessment of tricuspid valve function include:
- The valve morphology is normal
- The colour flow TR jet is small, central, which is consistent with mild TR
- The CW signal of TR jet is faint/parabolic, also consistent with mild TR
- The semi-quantitative and quantitative parameters provided do not meet the criteria for moderate or severe TR as defined by 1 Regular cardiac follow-up with routine echocardiography is appropriate to monitor for any changes in valve function over time, as recommended by the American College of Cardiology/American Heart Association 1.
From the Research
Tricuspid Valve Structure and Function
- The tricuspid valve is a crucial component of the heart, and its normal function is essential for maintaining cardiac health 2, 3.
- Tricuspid regurgitation (TR) is a condition where the tricuspid valve does not close properly, allowing blood to flow backward into the right atrium 2, 3, 4.
- The severity of TR can be assessed using various parameters, including TR gradient, TR velocity, and right ventricular systolic pressure (RVSP) 2, 3.
Assessment and Management of Tricuspid Regurgitation
- Severe TR is a progressive condition associated with substantial morbidity, poor quality of life, and increased mortality 2, 3, 4.
- The optimal timing of referral for isolated tricuspid valve intervention is undefined, and TV surgery has been associated with elevated risk of morbidity and mortality 2.
- Transcatheter TV interventions (TTVI) are a growing area of interest, offering a potentially safer and more effective treatment option for patients with severe TR 2, 3.
- A medical framework to optimize TR before referral for TTVI is essential, including the assessment of TR severity, right ventricular function, and other coexisting conditions 2.
Monitoring and Follow-up
- Monitoring patients with TR is crucial to detect any deterioration in their condition and to ensure timely intervention 5, 6.
- Intensive care nurses play a vital role in assessing changes in patients' conditions and preventing deterioration 6.
- A sensitive and attentive approach to patient care, including being present at the bedside, working in a concentrated and systematic manner, and being trained and familiar with routines, is essential for providing safe care 6.