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Tricuspid valve regurgitation

Overview

Tricuspid valve regurgitation

In tricuspid valve regurgitation, shown in the heart on the right, the valve between the two right heart chambers (right ventricle and right atrium) doesn't close properly. As a result, blood flows backward into the right atrium. A typical heart is shown on the left.

Tricuspid valve regurgitation is a type of heart valve disease in which the valve between the two right heart chambers (right ventricle and right atrium) doesn't close properly. As a result, blood leaks backward into the upper right chamber (right atrium).

A person may be born with tricuspid valve regurgitation (congenital heart disease). Sometimes, tricuspid valve regurgitation results from valve problems caused by other health conditions.

Mild tricuspid valve regurgitation may not cause symptoms or require treatment. If the condition is severe and causing signs and symptoms, medications or surgery may be needed.

Symptoms

Tricuspid valve regurgitation often doesn't cause signs or symptoms until the condition is severe. The condition may be discovered when tests are done for other reasons.

Signs and symptoms of tricuspid valve regurgitation may include:

  • Fatigue
  • Heart rhythm problems (arrhythmias)
  • Pulsing in the neck
  • Shortness of breath with activity
  • Swelling in the belly area (abdomen), legs or neck veins

When to see a doctor

Make an appointment with a health care provider if you are feeling easily fatigued or short of breath with activity. Your health care provider may refer you to a doctor trained in heart conditions (cardiologist).

Causes

Chambers and valves of the heart

A typical heart has two upper and two lower chambers. The upper chambers — the right and left atria — receive incoming blood. The lower chambers — the right and left ventricles — pump blood out of your heart. The heart valves, which keep blood flowing in the right direction, are gates at the chamber openings (for the tricuspid and mitral valves) and exits (for the pulmonary and aortic valves).

Ebstein anomaly

Ebstein anomaly is a rare congenital heart defect in which the tricuspid valve is incorrectly formed and positioned lower than usual in the heart. Atrial septal defect is a hole between the two upper chambers of the heart. About half the people with Ebstein anomaly have an atrial septal defect.

To understand the causes of tricuspid valve regurgitation, it may be helpful to know how the heart and heart valves typically work.

A typical heart has four chambers. The two upper chambers (atria) receive blood. The two lower chambers (ventricles) pump blood. Four valves open and close to keep blood flowing in the correct direction. These heart valves are:

  • Aortic valve
  • Mitral valve
  • Tricuspid valve
  • Pulmonary valve

The tricuspid valve sits between the heart's two right chambers. The tricuspid valve consists of three thin flaps of tissue (called cusps, or leaflets). These valve flaps open to let blood flow from the upper right chamber (right atrium) to the lower right chamber (right ventricle). The valve flaps then close tightly to prevent the blood from moving backward.

In tricuspid valve regurgitation, the tricuspid valve doesn't close tightly. As a result, blood leaks backward into the right atrium.

Tricuspid valve regurgitation can be caused by:

  • Heart defects present at birth (congenital heart defects). Some congenital heart defects can affect the shape and function of the tricuspid valve. Tricuspid valve regurgitation in children is usually caused by a rare congenital heart defect called Ebstein anomaly. In this condition, the tricuspid valve is malformed and sits lower than usual in the right ventricle.
  • Genetic disorders. Marfan syndrome is a connective tissue disorder occasionally associated with tricuspid valve regurgitation.
  • Rheumatic fever. This complication of untreated strep throat can damage the tricuspid valve and other heart valves, causing valve regurgitation later in life.
  • Infection of the lining of the heart (infective endocarditis). An infection of the lining of the heart can damage the tricuspid valve.
  • Carcinoid syndrome. In this rare condition, tumors that develop in the digestive system and spread to the liver or lymph nodes produce a hormonelike substance that can damage heart valves, most commonly the tricuspid valve and pulmonary valves.
  • Chest injury (trauma). Experiencing trauma to the chest, such as in a car accident, may cause damage that leads to tricuspid valve regurgitation.
  • Pacemaker or cardiac device wires. Tricuspid valve regurgitation sometimes occurs during the placement or removal of pacemaker and defibrillator wires, which cross the tricuspid valve.
  • Heart muscle (endomyocardial) biopsy. In this procedure, a small amount of heart muscle tissue is removed and tested for signs of inflammation or infection. Valve damage can sometimes occur during this biopsy.
  • Radiation therapy. Receiving radiation to the chest, for example during cancer treatment, may damage the tricuspid valve and cause tricuspid valve regurgitation.

Risk factors

Several things can increase the risk of tricuspid valve regurgitation, including:

  • Congenital heart defects, such as Ebstein anomaly
  • Heart attack
  • Heart failure
  • High blood pressure (hypertension)
  • High blood pressure in the lungs (pulmonary hypertension)
  • Infections affecting the heart, such as rheumatic fever and infective endocarditis
  • Radiation to the chest area
  • Use of certain stimulants and medications used to treat Parkinson's disease and migraines
  • Weakened heart muscle (cardiomyopathy)

Complications

Potential complications of tricuspid valve regurgitation may include:

  • Atrial fibrillation (A-fib). Some people with severe tricuspid valve regurgitation also may have A-fib, a common heart rhythm disorder.
  • Heart failure. Severe tricuspid valve regurgitation can cause pressure to rise in the right lower chamber (ventricle). The right ventricle can expand and weaken over time, leading to heart failure.

Diagnosis

Tricuspid valve regurgitation can occur silently. In children, the condition may not be diagnosed until adulthood. Tricuspid valve regurgitation may be discovered when imaging tests of the heart are done for other reasons.

Tests

If your health care provider thinks you may have tricuspid valve regurgitation, several tests may be done to confirm the diagnosis and determine the cause and severity. Results of testing can help your health care provider develop an appropriate treatment plan.

Tests to diagnose tricuspid valve regurgitation may include:

  • Echocardiogram. This is the main test used to diagnose tricuspid valve regurgitation. An echocardiogram uses sound waves to create detailed images of the beating heart. The test can show the structure of the heart and heart valves, including the tricuspid valve, and the flow of blood through the heart areas.

    A standard echocardiogram, called a transthoracic echocardiogram, creates images of the heart using a device called a transducer that's moved gently across the skin on the chest. If more-detailed images are needed, your health care provider may recommend a transesophageal echocardiogram. During this procedure, a flexible tube containing the transducer is guided down your throat and into the tube connecting your mouth to your stomach (esophagus). Because the esophagus lies close to your heart, this type of echocardiogram provides more information about the heart and heart valves.

  • Cardiac MRI. Magnetic fields and radio waves are used to create detailed images of your heart. A cardiac MRI may be used to determine the severity of tricuspid valve regurgitation and assess the size and function of your lower right heart chamber (right ventricle).
  • Electrocardiogram (ECG or EKG). This quick and painless test measures the electrical activity of the heart. Sticky patches (electrodes) are placed on the chest and sometimes the arms and legs. Wires connect the electrodes to a computer, which displays the test results.
  • Chest X-ray. A chest X-ray shows the condition of the heart and lungs.
  • Exercise stress test. Different exercise tests can be done to show how your heart works during physical activity. You walk on a treadmill or ride a stationary bike while your heart rhythm, blood pressure and breathing are monitored. If you are not able to exercise, medications to mimic the effect of exercise on your heart may be used.
  • Cardiac catheterization. Rarely, cardiac catheterization may be done to determine certain causes of tricuspid valve regurgitation and to help decide on treatment.

    In this procedure, a doctor inserts a long, thin tube (catheter) into a blood vessel, usually in the groin, and guides it to the heart using X-ray imaging. A special dye injected through the catheter shows blood flow through the heart, blood vessels and valves.

Treatment

Treatment for tricuspid valve regurgitation depends on the cause and severity of the condition. The goals of treatment are to:

  • Reduce signs and symptoms
  • Prevent complications
  • Improve quality of life

If you have mild tricuspid valve regurgitation, you may not need regular follow-ups. For more severe regurgitation you may need regular appointments to monitor your condition.

If tricuspid valve disease is due to an underlying condition or congenital heart defect, you may need medications, a catheter procedure, or surgery to repair or replace the valve.

Medications

Your health care provider may prescribe medications to control symptoms or to treat an underlying condition that is causing tricuspid regurgitation. Medications may include:

  • Drugs to eliminate extra fluids from the body (diuretics)
  • Drugs to control irregular heartbeats (anti-arrhythmics)
  • Other drugs to treat or control heart failure

Surgery or other procedures

Some people with tricuspid valve regurgitation may need surgery to repair or replace the valve. Valve repair or replacement may be done as open-heart surgery or as a minimally invasive heart surgery. Sometimes a tricuspid valve problem may be treated with a catheter-based procedure.

A health care provider may recommend tricuspid valve repair or replacement surgery if:

  • You have severe tricuspid valve regurgitation with signs or symptoms
  • You have swelling (enlargement) of the heart with or without signs and symptoms
  • You have tricuspid valve regurgitation and need heart surgery for another condition, such as mitral valve disease

Surgery or other procedures to treat tricuspid valve regurgitation include:

  • Tricuspid valve repair. Tricuspid valve repair is usually done with open-heart surgery. Repair may include patching holes or tears in the valve, reshaping or removing tissue to help the valve close more tightly, separating valve flaps (leaflets), or adding support to the valve base or roots.

    The cone procedure is a type of valve repair surgery used to treat tricuspid regurgitation in people with Ebstein anomaly, a congenital heart defect. The heart surgeon separates the leaflets that close off the tricuspid valve from the underlying heart muscle. The leaflets are then rotated and reattached.

    Tricuspid valve repair helps preserve heart function. It also may reduce the potential need for long-term use of blood thinners.

  • Tricuspid valve replacement. If the tricuspid valve can't be repaired, the surgeon may remove the damaged or diseased valve and replace it with a mechanical valve or a valve made from cow, pig or human heart tissue (biological tissue valve).

    If you have a mechanical valve, you'll need to take blood-thinning medications for life to prevent blood clots. However, biological tissue valves can break down over time, and often eventually need to be replaced. Together, you and your health care provider can discuss the risks and benefits of each type of heart valve to determine the best one for you.

  • Catheter procedure. If you have a biological tissue tricuspid valve that's no longer working, a catheter procedure may be done instead of open-heart surgery to replace the valve. The doctor inserts a thin, hollow tube (catheter) into a vein and guides it to the tricuspid valve using X-rays as a guide. The replacement valve is passed through the catheter into the existing biological valve.
  • Other procedures. If tricuspid valve regurgitation is causing heart rhythm problems (arrhythmias), catheter ablation or a type of open-heart surgery called the maze procedure may be done to block faulty heart signals that trigger irregular heartbeats.

Lifestyle and home remedies

Your health care provider may recommend that you make some lifestyle changes to improve your heart health and to manage tricuspid valve regurgitation, including:

  • Eat a heart-healthy diet. Eat a variety of fruits and vegetables, whole grains, and lean proteins. Avoid saturated fats and trans fats, sugar, salt, and refined grains.
  • Exercise. Exercise can help improve your heart health. However, check with your health care provider before you begin an exercise plan, especially if you're interested in participating in competitive sports. The amount and type of exercise your health care provider recommends for you may depend on your condition, if you have other heart valve conditions and if your condition is caused by other conditions.
  • Prevent heart infections. If you have had a heart valve replaced, your health care provider may recommend that you take antibiotics before dental procedures to prevent an infection of the heart's inner lining (infective endocarditis). Ask your health care provider if you need antibiotics before dental procedures.
  • Prepare for pregnancy. If you have tricuspid valve regurgitation and you're thinking about becoming pregnant, talk with your health care provider first. If you have severe tricuspid valve regurgitation, you'll need to be monitored by a doctor trained in heart disease (cardiologist) and a medical team experienced in treating women with heart valve conditions during pregnancy.

    If tricuspid valve regurgitation is due to a congenital heart condition, such as Ebstein anomaly, you need to be evaluated by a doctor trained in congenital heart disease.

  • See your health care provider regularly. Schedule regular checkups with your cardiologist or primary care provider. Let your health care provider know if you have any changes in your signs or symptoms.

Coping and support

If you have tricuspid valve regurgitation, here are some steps that may help you manage the condition and ease stress or anxiety:

  • Take medications as prescribed. Take your medications as directed. Tell your health care provider about all the medications you take, including those bought without a prescription.
  • Get support. Having support from your family and friends can help you cope with your condition. Ask your health care provider about support groups that may be helpful.
  • Stay active. It's a good idea to stay physically active. Your health care provider may give you recommendations about how much and what type of exercise is appropriate for you.

Preparing for an appointment

If your health care provider thinks you might have tricuspid valve regurgitation, you will likely be referred to a doctor who specializes in treating heart conditions (cardiologist).

Here's some information to help you get ready, and what to expect from your health care provider.

What you can do

  • Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if you need to do anything in advance, such as restrict your diet.
  • Write down any signs and symptoms you are having, including any that may seem unrelated to the reason for which you scheduled the appointment.
  • Make a list of any medications, vitamins or supplements that you're taking.
  • Consider taking a family member or friend along. Sometimes it can be difficult to remember all the information provided during an appointment. Someone who goes with you may remember something that you missed or forgot.
  • Write down questions to ask the health care provider.

Your time with the health care provider is limited, so preparing a list of questions can help you make the most of your time together. For tricuspid valve regurgitation, some basic questions to ask your health care provider include:

  • What's the most likely cause of my symptoms?
  • What tests do I need? Do these tests require any special preparation?
  • I feel OK. Do I even need treatment?
  • What treatments are available, and which do you recommend?
  • Is there a generic alternative to the medicine you're prescribing me?
  • What are the side effects of treatment?
  • How much experience does the surgeon have repairing tricuspid valves?
  • Will I need tricuspid valve repair or replacement again in the future?
  • Are there any alternatives to the primary treatment that you're suggesting?
  • I have other health conditions. How can I best manage these conditions together?
  • Do I need to restrict my activity in any way?
  • Are there any brochures or other printed material that I can take home with me?
  • Can you recommend any websites for more information on my condition?

In addition to the questions that you've prepared to ask, don't hesitate to ask questions during your appointment if you don't understand something.

What to expect from your doctor

Your health care provider is likely to ask you a number of questions. Being ready to answer them may save time to go over any questions or concerns you want to spend more time on. Your health care provider may ask:

  • When did you first notice symptoms?
  • Have your symptoms been continuous or occasional?
  • Does anything seem to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
  • If you've already been diagnosed with tricuspid valve regurgitation, when and where was the diagnosis made?
  • Have you had any surgery or ever been hospitalized?
  • What medications are you taking?
Last Updated: October 26th, 2021