Trace Mitral and Tricuspid Regurgitation Guidelines

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 2

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 3
Trace regurgitation differs significantly from pathological regurgitation based on several echocardiographic parameters, including mild/trace MR: Small, central jet with faint/parabolic CW signal 4
Trace regurgitation differs significantly from pathological regurgitation based on several echocardiographic parameters, including mild/trace TR: Small, central jet with faint/parabolic CW signal and normal right heart chambers 5

Regurgitation becomes clinically significant when tricuspid regurgitation has a Vena contracta width ≥7mm, large flow convergence, systolic flow reversal in hepatic veins, or right atrial/ventricular enlargement 5
Regurgitation becomes clinically significant when mitral regurgitation has a Vena contracta width ≥7mm, large central jet or eccentric wall-impinging jet, dense/triangular CW signal, or left atrial/ventricular enlargement 4
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 6

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 3
In the absence of symptoms, structural valve abnormalities, chamber enlargement, or pulmonary hypertension, trace mitral and tricuspid regurgitation does not require endocarditis prophylaxis 3
In the absence of symptoms, structural valve abnormalities, chamber enlargement, or pulmonary hypertension, trace mitral and tricuspid regurgitation does not require 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 5, 4