What is the diagnosis for a patient with a tricuspid valve (TV) showing trivial regurgitation, normal structure, and a tricuspid regurgitation (TR) velocity of 1.2 meters per second (m/s)?

From the Guidelines

The tricuspid valve is normal with trivial regurgitation and no stenosis, and no intervention is needed as all parameters are within normal limits. The inferior vena cava (IVC) caliber is 1.3 cm, which is within normal limits, suggesting normal right atrial pressure, as indicated in the 2014 AHA/ACC guideline for the management of patients with valvular heart disease 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 during regurgitation. Based on these findings, the right ventricular systolic pressure (RVSP) is likely normal, as the TR velocity is low. Some key points to consider in the assessment of the tricuspid valve include:

• The valve structure is normal, with no evidence of stenosis or significant regurgitation
• The IVC caliber and right atrial pressure are within normal limits
• The TR velocity is low, indicating a low pressure gradient across the valve
• The patient's symptoms and clinical findings are not suggestive of significant tricuspid regurgitation or other valvular heart disease. According to the 2020 European Heart Journal position statement on recommendations for participation in competitive sport in adolescent and adult athletes with congenital heart disease, pulmonary hypertension is excluded when TR velocity is <2.8 m/s, and there are no additional echocardiographic variables suggestive of PH present 1. In this case, the TR velocity is 1.2 m/s, which is well below the threshold for concern. Regular cardiac follow-up with routine echocardiography is recommended to monitor for any changes over time, but no specific treatment is required for the tricuspid valve at this time. The trivial regurgitation is a common finding even in healthy individuals and is not clinically significant.

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, 4.
• Tricuspid regurgitation (TR) is a common lesion of the tricuspid valve, with mild TR being common and usually benign, but moderate or severe TR can lead to irreversible myocardial damage and adverse outcomes 4.

Diagnosis and Treatment of Tricuspid Valve Disease

• 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, with surgical annuloplasty or valve replacement considered in patients with progressive RV dilatation without severe LV dysfunction and pulmonary hypertension 2, 3.
• Transcatheter repair/replacement is an emerging therapy for high-risk patients with TR who would otherwise have a dismal clinical prognosis 2, 3, 5.

Tricuspid Regurgitation Severity and Outcome

• The severity of TR is associated with mortality, and a low use of surgical solutions in the setting of high in-hospital mortality attributed to the late presentation of the disease 5.
• Accurate diagnosis of TR severity is crucial to determine appropriate management solutions, with multi-parametric echocardiographic approach and multi-modality imaging playing a key role 5.

Tricuspid Valve Imaging and Intervention

• Tricuspid valve abnormalities in congenital heart disease comprise a wide spectrum, with the most common being Ebstein anomaly and tricuspid valve dysplasia 6.
• Surgical treatment of tricuspid valve disease remains the mainstay of therapy, with primary catheter-based interventions being uncommon, but tricuspid valve-in-valve catheter-based replacement being a possible option for patients with a bioprosthesis 6.