From the Guidelines
The tricuspid valve assessment shows normal structure and function with only trivial regurgitation, indicating no significant pathology requiring intervention. The valve demonstrates appropriate respiratory variation (>50%) and normal TR gradient variation, with no evidence of stenosis. The inferior vena cava (IVC) caliber is normal at 1.3 cm, and the right atrial pressure is low at 3 mmHg. The tricuspid regurgitation velocity is 1.2 m/s, which corresponds to a normal right ventricular systolic pressure. These findings collectively indicate a normally functioning tricuspid valve with no significant pathology requiring intervention. The trivial regurgitation noted is considered a physiologic finding present in many healthy individuals and does not require treatment, as supported by the guidelines on the management of valvular heart disease 1.
The normal IVC size and respiratory variation further support adequate right heart function without evidence of right-sided heart failure or pulmonary hypertension. According to the 2014 AHA/ACC guideline for the management of patients with valvular heart disease, the patient's condition is classified as Stage A, at risk of TR, with no or trace TR and no symptoms 1. No specific medications or interventions are needed based on these findings, and routine cardiac follow-up would be appropriate.
Key points to consider in this patient's management include:
- Monitoring for signs of right heart failure or pulmonary hypertension
- Assessing liver function to detect any potential hepatic dysfunction due to elevated right atrial pressure
- Using transthoracic echocardiography (TTE) to distinguish primary from functional TR and estimate pulmonary artery systolic pressure
- Measuring tricuspid annular diameter in the apical 4-chamber view to assess for significant annular dilation and increased risk of persistent or progressive TR.
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 normal tricuspid valve anatomy and function have several dissimilarities to the corresponding mitral valve in the left heart, in part, based on lower pressures in the right heart chambers 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.
- Tricuspid regurgitation is frequently encountered and is most often secondary in nature and caused by annular dilatation and leaflet tethering from adverse right ventricular remodelling in response to any of several disease processes 5.
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.
- The treatment of tricuspid valve disease is guided by underlying etiology and pathology 3.
- Tricuspid valve repair is increasingly advocated for patients with advanced tricuspid regurgitation, especially when combined with surgery on the left heart pathology 3.
- 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.
Prognosis
- The five-year survival with severe TR and HFrEF is 34% 4.
- Tricuspid valve disease, and particularly tricuspid regurgitation, is a highly prevalent condition with a complex pathophysiology and long-term adverse consequences 6.
- Surgical treatment remains the standard of care, but it continues to have one of the highest death rates among all cardiac valve-related procedures 6.