From the Guidelines
For a 31-year-old male with normal ejection fraction (EF) of 60%, trace mitral valve regurgitation, and trace tricuspid regurgitation, no specific treatment or medication is needed, as these findings are considered normal or near-normal cardiac function, according to the 2014 AHA/ACC guideline for the management of patients with valvular heart disease 1. These trace valve regurgitations are classified as "at risk of MR" (Grade A) with no MR jet or small central jet area <20% LA on Doppler, and small vena contracta <0.30 cm, which does not require intervention 1. I recommend continuing routine health maintenance with regular check-ups every 1-2 years, maintaining a heart-healthy lifestyle including:
- Regular exercise (150 minutes of moderate activity weekly)
- A balanced diet low in sodium and saturated fats
- Avoiding tobacco
- Limiting alcohol consumption
- Maintaining healthy weight These trace valve findings don't restrict physical activity or require antibiotic prophylaxis before dental procedures. The normal ejection fraction indicates good heart pumping function, and the minimal valve leakage is not hemodynamically significant enough to cause symptoms or require monitoring beyond routine care, as stated in the guideline 1. If symptoms like chest pain, shortness of breath, palpitations, or decreased exercise tolerance develop, follow-up evaluation would be warranted.
From the Research
Recommendations for a 31-year-old male with a 2D echo showing normal EF of 60%, trace mitral valve regurgitation, and trace tricuspid regurgitation
- The patient's left ventricular ejection fraction (LVEF) of 60% is considered normal 2.
- Trace mitral valve regurgitation and trace tricuspid regurgitation are mild conditions that may not require immediate intervention 3, 4.
- However, studies have shown that even mild mitral regurgitation can have a significant impact on left ventricular function and clinical outcomes 3, 5.
- The presence of tricuspid regurgitation may also be a predictor of worsened follow-up LVEF in patients undergoing mitral valve surgery 5.
- The patient's age and normal LVEF suggest that they may be a good candidate for watchful waiting and regular monitoring of their condition 6.
- Regular echocardiograms and clinical evaluations should be performed to monitor the patient's condition and adjust treatment as needed 3, 4, 5, 6.
Factors to Consider
- Preoperative LVEF and left ventricular end-systolic diameter (LVESD) can impact postoperative LVEF and clinical outcomes 4, 6.
- The type of mitral valve intervention (repair or replacement) and the presence of concomitant tricuspid valve procedures can also impact clinical outcomes 3, 4.
- Rhythm control therapy may be beneficial for patients with atrial fibrillation and mitral regurgitation 3.