Is trace mitral (mitral valve) and tricuspid (tricuspid valve) regurgitation a normal finding in a 36-year-old female?

Trace Mitral and Tricuspid Regurgitation in a 36-Year-Old Female

Trace mitral and tricuspid regurgitation is a normal finding in a 36-year-old female and does not require intervention or follow-up. 1

Normal Physiological Finding

• Trace to mild tricuspid and mitral valve regurgitation is commonly detected by Doppler echocardiography in healthy individuals without structural heart disease 1
• Normal pregnancy is accompanied by echocardiographic evidence of mild ventricular chamber enlargement, and most women demonstrate Doppler evidence of "physiological" mitral regurgitation in the absence of structural valve disease 1
• Pulmonic and tricuspid valvular regurgitation, as assessed by Doppler interrogation, is the rule rather than the exception in normal individuals 1

Distinguishing Normal from Pathological Regurgitation

• Clinically insignificant tricuspid regurgitation is detected by color Doppler imaging in many normal persons and is not an indication for either routine follow-up or prophylaxis against bacterial endocarditis 1
• Trace regurgitation differs significantly from pathological regurgitation based on several echocardiographic parameters:
  • Mild/trace MR: Small, central jet with faint/parabolic CW signal 1
  • Mild/trace TR: Small, central jet with faint/parabolic CW signal and normal right heart chambers 1

When to Be Concerned

• Regurgitation becomes clinically significant when:
  • Tricuspid regurgitation: Vena contracta width ≥7mm, large flow convergence, systolic flow reversal in hepatic veins, or right atrial/ventricular enlargement 1
  • Mitral regurgitation: Vena contracta width ≥7mm, large central jet or eccentric wall-impinging jet, dense/triangular CW signal, or left atrial/ventricular enlargement 1
• Significant tricuspid regurgitation is associated with elevated pulmonary artery pressures (>55 mmHg), whereas TR occurring with systolic pulmonary artery pressures <40 mmHg is likely to reflect a structural abnormality of the valve apparatus 1

Risk Factors for Progressive Regurgitation

• Female sex is a risk factor for development of more significant tricuspid regurgitation over time 2
• Other risk factors for progression include:
  • Preexisting atrial fibrillation 3
  • Diabetes mellitus 3
  • Elevated right ventricular systolic pressure 2
  • Older age 2

Clinical Implications

• In the absence of symptoms, structural valve abnormalities, chamber enlargement, or pulmonary hypertension, trace mitral and tricuspid regurgitation does not require:
  • Routine follow-up echocardiography 1
  • Endocarditis prophylaxis 1
  • Any specific treatment or intervention 1
• The European Association of Cardiovascular Imaging confirms that trace regurgitation falls below the threshold for even "mild" regurgitation in formal grading systems 1

Conclusion

Trace mitral and tricuspid regurgitation in a 36-year-old female represents a normal physiological finding that does not require clinical intervention or follow-up. This is supported by multiple cardiology guidelines that recognize the presence of minimal regurgitation as a common finding in healthy individuals 1. Clinical judgment should accompany echocardiographic results, as the finding of trace regurgitation alone without other abnormalities is not clinically significant.