The tricuspid valve is a valve located between the right upper and right lower chambers of the heart.
This valve controls the flow of blood in a single direction.
Tricuspid regurgitation occurs when the valve does not close well. In essence the valve cannot seal tightly enough resulting in a backflow of blood in the opposite direction. This results in a significant amount of blood volume re-entering the right atrium and raises the pressures in the chamber.
When this happens symptoms of congestion can occur.
What are the causes of tricuspid valve regurgitation?
|Valve leaflets||Valve leaflet damaged||Valve leaflet not damaged but valve cannot close due to enlargement of the heart and valves are pulled apart.|
|Examples||Infection – infective endocarditis
Congenital heart defects
Trauma from pacemakers wires
Post radiation treatment
Carcinoid syndrome (rare)
|Associated with atrial fibrillation – an irregular heartbeat
Left heart valve disease
What are the risk factors of tricuspid valve regurgitation
- Prior or co-existing left heart disease (e.g. heart failure)
- High lung pressures (pulmonary hypertension)
- Infections of the valves (endocarditis or rheumatic fever)
- Heart attacks
- History of chest radiation for cancer
- Medications (e.g. some drugs used to treat parkison’s disease or migraines)
- Inborn heart condition
What is the impact of tricuspid regurgitation on the body?
When the regurgitation is mild or moderate there is often no significant impact. When the regurgitation becomes severe, the patients often experience significant congestion. They could experience the following:
- Fluttering sensation of neck veins
- Leg swelling
- Abdominal swelling
- Poor appetite
- Shortness of breath
- Leg cramps
- Jaundice (late-stage)
How is tricuspid regurgitation assessed and diagnosed?
This is done using a transthoracic echocardiogram. This is an ultrasound technique which allows visualization of the valve as well as to quantify the degree of regurgitation. Occasionally blood tests may be conducted to assess the impact of the tricuspid regurgitation on the body. These may include tests to assess the function of the liver as well as the kidneys as these organs may bear the brunt of the congestion.
How is tricuspid regurgitation treated?
Conventionally, these were only treated by open heart surgery through valve repair or valve replacement techniques. Patients may also require large amounts of diuretics ( medications to expel water via increasing urine excretion) to reduce congestion. There are now alternatives to these. These include percutaneous techniques to reduce the leakage of the valves by clipping the valve leaflets ( tightening the valves) or by implanting stented valves to shield the body from the harmful effects of the tricuspid regurgitation. These techniques are especially useful when patients are deemed high risk for open surgery.
What is the prognosis of tricuspid regurgitation?
This is dependent on the type and degree of tricuspid valve regurgitation. Mortality increases with the increased severity of tricuspid regurgitation. One large study reported a survival rate of 64%1. A more contemporary study showed a survival rate of 78.2% over a mean follow-up of over 1000 days2.
- Nath J, Foster E, Heidenreich PA. Impact of tricuspid regurgitation on long-term survival. J Am Coll Cardiol. 2004 Feb 4;43(3):405-9
- Bannehr M, Edlinger CR, Kahn U, Liebchen J, Okamoto M, Hähnel V, Dworok V,Schipmann F, Kücken T, Bramlage K, Bramlage P, Haase-Fielitz A, Butter C. Natural course of tricuspid regurgitation and prognostic implications. Open Heart. 2021 Feb;8(1):e001529.