Dr.S.Venkatesan MD

The greatest  adverse effect of modern medical science is the  notorious phenomenon  of  amplifying  medical trivia .We rarely realise how much of anxiety this causes to our patients. We can’t complain either, as many of the medical professionals make a living out this.

For  cardiologists and echocardiologists , there is  often an  issue  in  reporting  some of their findings .Doppler is a great tool , especially the  color Doppler  which can pickup even few clusters  of RBCs that leak into atria  every time the AV valves closes. Ideally this  has to be  labeled as physiological MR or TR .If the arotic root is obliquely aligned with it’s leaflets one  may even  get a physiological AR .

While  it is better to ignore these lesions , some call it as Trivial MR / TR/AR .

This can be detected up to 40 % of individuals.

What does trivial regurgitation  mean to a doctor ?

It means nothing . Few may  use  it as  a weapon to advice further visits to their  clinic and do serial meaningless  follow up scans .The irony is   some of these  patients  enjoy this  . . . and it  becomes a different matter altogether.

What does it mean to the patient?

Anxiety for the majority  ,   for the modern net educated public. No issue ,  for the ignorant and the take  it easy men !  We have seen number of patients getting cardiac symptoms after reporting the physiological MR or TR.

So, should we report physiological events in routine echocardiogrpahy?

We need not . But we do it often .Why ?

There are few  reasons for this phenomenon ( Which  I believe are true  , after observing as many echocardiography centers for more than few decades)

• Doctors and Imageologist are often self suspicious and worried about missing something and getting exposed among their peers and public. They do not want to miss any abnormality. So even a trival abnormality of negligible importance is also reported.
• In the prevailing  Geo commercial medical world there are issues other than  academic  creeping in..

• Many get bored to  report normal reports  as they  want to add spice to their report hence they fill it up all fancy terminologies . This sort of spice reporting adds self esteem the medical  professionals .It makes some sense to report and reveal what they know to the non specialists.
• Finally, the present day high IQ patients also do not expect a bland ( normal ) report.They often relish  some scribblings in their master health check reports. They tend to  question the authenticity  if we simply say  everything is normal.

The following can be termed as Echo trivia in otherwise healthy individual

• Mild LVH
• Age related impaired relaxation of LV without LA enlargement.
• Mitral valve prolapse without MR
• Minimal pericardial effusion
• Patent foramen ovale  without any shunting

When does a trivial lesions can be important ?

In a patient with established heart disease  , a trivial valve leak could become important. For example  in dilated cardiomyopathy, COPD, MVPS dilated aortic root etc .Here regular  follow ups may be necessary.

Aortic and mitral valve degeneration with calcification in the elderly is now implicated in many of the unexplained strokes .Hence  even though it is  age related physiology it need to be given importance.

Can trivial regurgitant lesions be a risk for infective endocarditis.?

No one knows. Logic would  imply a risk ,  as micro jets are  the norm here . But the potential for it to cause a endothelial damage is negligible. Some sinister thinking cardiologists    Many of the native valve endocarditis in otherwise normal hearts may be attributed to this physiological MR/TR .(Evidence less cardiology !)

Clinical use of physiological TR and MR ?

The physiological TR,MR jet helps us to estimate pulmonary arterial pressure and LA mean pressure. Systemic cuff pressure minus MR jet pressure give us LAP.TR jet plus RA pressure give an estimate of PA pressure .