Tricuspid Valve Regurgitation

What is tricuspid valve regurgitation?

Tricuspid valve regurgitation occurs when the heart’s tricuspid valve doesn’t close as it should. The tricuspid valve separates the upper chamber (atrium) and lower chamber (ventricle) on the right side of the heart. When the tricuspid valve doesn’t close properly, blood flows the wrong way — it regurgitates backward — into the upper chamber every time your heart beats.

Tricuspid valve regurgitation is a type of heart valve disease. You may also hear the terms leaky tricuspid valve, tricuspid insufficiency, and tricuspid regurgitation.

Trace or mild tricuspid valve regurgitation are milder forms of tricuspid valve disease that don’t cause problems or need treatment. Moderate to severe tricuspid regurgitation can lead to heart failure and other serious complications, so some patients need treatment.

Heart specialists at Mass General Brigham Heart and Vascular perform advanced procedures to treat tricuspid valve disease. We offer medication therapies, as well as catheter-based and surgical tricuspid valve repair and replacement procedures.
 

What is the tricuspid valve?

The tricuspid valve is a fibrous ring (annulus) with three leaflets or flaps. Several valve actions happen when your heart beats:

• The tricuspid valve leaflets open when the heart relaxes between heart beats. An open valve allows blood to flow from the upper right chamber into the lower right chamber.
• The lower right chamber pushes blood through a different valve (the pulmonary valve) into the main pulmonary artery.
• The main pulmonary artery splits into right and left pulmonary arteries. These arteries carry unoxygenated blood from the heart to the lungs to get oxygen.
• The tricuspid valve leaflets close when your heart contracts or beats. A closed valve stops blood from flowing back into the upper chamber.

Other tricuspid valve diseases

In addition to regurgitation, other conditions can affect the tricuspid valve. These conditions have different causes, symptoms, and treatments.

Tricuspid valve regurgitation symptoms

Tricuspid valve regurgitation symptoms vary depending on the leakage severity. Mild or trace tricuspid valve regurgitation may not cause symptoms. Symptoms may be noticeable when the regurgitation is more severe.

Common tricuspid valve regurgitation symptoms include:

• Extreme, persistent fatigue
• Pulsing or throbbing in neck veins
• Racing, pounding heartbeat or irregular heartbeat
• Shortness of breath, especially during exertion
• Swollen veins in the feet or legs
• Abdominal fullness and loss of appetite

Causes of tricuspid valve regurgitation

Many conditions can cause a leaky tricuspid valve. An enlarged right ventricle, which causes an enlarged heart (cardiomegaly), is the most common cause. Increased pressure from these heart conditions can cause an enlarged heart:

• Atrial fibrillation
• Cardiomyopathy
• Having a pacemaker device
• Other types of heart valve disease or previous heart valve infection
• Pulmonary hypertension

Risk factors for tricuspid valve regurgitation

Having one or more of these conditions increases your risk of tricuspid valve regurgitation:

• Aortic stenosis
• Carcinoid syndrome
• Cardiac arrhythmias
• Congenital heart disease, including Ebstein’s anomaly
• Endocarditis
• Marfan syndrome
• Mitral valve regurgitation
• Rheumatic fever

Preventing tricuspid valve regurgitation

These actions can improve heart health, lowering your risk of valve disease:

• Choose heart-healthy foods
• Get help to quit smoking
• Limit alcohol
• Maintain a healthy weight and cholesterol levels
• Manage diabetes, high blood pressure, and high cholesterol
• Walk or do other physical activities

Diagnosis of tricuspid valve regurgitation

A healthcare provider may detect a heart murmur during a physical examination. Heart murmurs are common, and most aren’t a sign of a serious heart problem.

But if you have a murmur and heart valve disease risk factors or symptoms, your provider may order one or more of these diagnostic tests:

• Echocardiogram (cardiac ultrasound), to view blood as it flows through heart valves
• Electrocardiogram (ECG/EKG), to measure the heart’s electrical activity
• Chest X-ray, to look at the heart and lungs
• Cardiac MRI, to determine the severity of regurgitation
• Cardiac catheterization, to measure blood flow and pressure inside the heart

Stages of tricuspid regurgitation

The four stages of heart valve disease range from at-risk (stage A) to severe disease with symptoms (stage D). Healthcare providers determine disease stage based on symptoms, disease severity, valve structures, and blood flow. The disease stage guides treatment.

The four stages of tricuspid valve regurgitation include:

1. At-risk: You have risk factors for heart valve disease that require monitoring.
2. Progressive: Mild valve disease doesn’t cause symptoms, but may require treatment.
3. Asymptomatic severe: Severe valve disease doesn’t cause symptoms, but may require treatment.
4. Symptomatic severe: Severe valve disease causes serious symptoms and may require treatment.

Treatment of tricuspid valve regurgitation

Mild or trace tricuspid valve regurgitation rarely requires treatment. However, your provider may recommend more frequent heart tests to monitor the condition. Moderate to severe tricuspid valve disease requires treatment to prevent serious heart complications.

Heart specialists at Mass General Brigham are experts at advanced tricuspid and pulmonary valve repair and replacement procedures. When possible, our team performs these procedures through catheter-based therapies instead of open-heart surgery. Minimally invasive cardiac surgery often means less blood loss, scarring, and infection risk. You benefit from a faster, less painful recovery.

FAQs about tricuspid valve regurgitation