What is the recommended management for a patient with trace regurgitation in the mitral and tricuspid valves, normal ejection fraction (EF), and no other significant heart abnormalities?

Management of Trace Mitral and Tricuspid Regurgitation with Normal Ejection Fraction

Trace mitral and tricuspid regurgitation with normal ejection fraction requires no specific intervention and only routine cardiac follow-up every 3-5 years in asymptomatic patients.

Understanding Trace Regurgitation

Trace regurgitation of the mitral and tricuspid valves is a very common and benign finding in patients with otherwise normal cardiac function. When accompanied by:

• Normal ejection fraction (65% in this case)
• Normal heart muscle movement
• No other valve abnormalities
• Normal right heart pressures (19 mmHg)
• Normal diastolic function

This represents a physiologic variant rather than pathologic condition requiring treatment.

Clinical Significance

Trace Mitral Regurgitation

• Defined as minimal backflow of blood from the left ventricle to the left atrium
• When "trace" in severity, it falls well below the threshold for clinical concern
• Does not meet any criteria for severe MR such as:
  • Vena contracta ≥7 mm
  • EROA ≥0.4 cm² (primary MR)
  • Regurgitant volume ≥60 mL/beat 1

Trace Tricuspid Regurgitation

• Represents minimal backflow from right ventricle to right atrium
• Normal finding in up to 70% of healthy individuals
• Not associated with adverse outcomes when:
  • Right ventricular function is normal
  • Right atrial pressure is normal (19 mmHg in this case)
  • No evidence of pulmonary hypertension 2

Surveillance Recommendations

For patients with trace mitral and tricuspid regurgitation and normal cardiac function:

• Asymptomatic patients with mild MR: Echocardiographic follow-up every 3-5 years 1
• No specific medical therapy is indicated for isolated trace regurgitation
• No need for antibiotic prophylaxis for procedures
• No activity restrictions

When to Consider More Frequent Monitoring

More frequent follow-up (every 1-2 years) would be warranted if:

• Regurgitation progresses to moderate severity
• Left ventricular function begins to deteriorate
• Right ventricular enlargement develops
• Symptoms develop (dyspnea, fatigue, decreased exercise tolerance)
• Pulmonary hypertension develops 1, 2

Potential Causes of Trace Regurgitation

Trace regurgitation can be:

1. Physiologic: Normal variant in healthy hearts
2. Secondary to volume status: Can improve or worsen with changes in volume status 3
3. Age-related: More common with increasing age due to minor valve degeneration
4. Secondary to mild annular dilation: Without significant structural abnormalities

Clinical Pearls and Pitfalls

Pearls:

• Trace regurgitation is often a normal finding and not pathologic
• Normal EF (65%) indicates preserved systolic function
• Normal right heart pressures (19 mmHg) rule out pulmonary hypertension

Pitfalls to Avoid:

• Overtreatment of trace regurgitation
• Causing unnecessary patient anxiety about a benign finding
• Ordering excessive follow-up studies for a physiologic variant

Conclusion

Trace mitral and tricuspid regurgitation with normal ejection fraction and normal cardiac structure represents a benign finding that requires no specific intervention beyond routine cardiac follow-up every 3-5 years in asymptomatic patients.