Tricuspid Valve Regurgitation

Causes of tricuspid valve regurgitation

Tricuspid regurgitation is most frequently caused by an enlarged ventricle (lower heart chamber). It could also be caused by tricuspid regurgitation, infective endocarditis, Marfan syndrome, rheumatoid arthritis, rheumatic fever or carcinoid tumors.

Risk factors for tricuspid valve regurgitation

Several conditions or diseases that increase the risk of developing tricuspid valve regurgitation include:

• Endocarditis or rheumatic fever
• Heart disease or a heart attack
• Heart failure
• Congenital heart disease
• Pulmonary hypertension

Symptoms of tricuspid valve regurgitation

Many patients do not have any symptoms of tricuspid valve regurgitation, but others have symptoms such as:

• Fatigue
• Enlarged liver
• Abdominal swelling
• Swelling in legs, ankles or feet
• Pulsing in the neck veins

Diagnosis of tricuspid valve regurgitation

Several diagnostic tests can diagnose tricuspid valve regurgitation including:

• Echocardiogram (echo) — most commonly used to diagnose tricuspid valve regurgitation, an echo can determine if there is leaking blood in the tricuspid valve.
• Transesophageal echocardiogram — provides more detailed images of the heart and valves, by inserting a device into the esophagus, which sits next to the heart.
• Electrocardiogram (ECG or EKG) — measures the electrical impulses of the heart to diagnose heart arrhythmias.
• Chest x-ray — takes pictures of the heart and lungs to determine if the heart is enlarged or if there is fluid in the lungs.
• Cardiac magnetic resonance imaging (MRI) — used to evaluate the size and function of the right ventricle to determine if you have tricuspid valve regurgitation.

Treatment for tricuspid valve regurgitation

The goal of treatment for patients with tricuspid valve regurgitation is to extend the patient’s life and reduce the severity of the symptoms. Your doctor will develop a treatment plan based on the severity of your condition and the cause of your disease.

By treating the underlying cause of your tricuspid valve regurgitation, you can also improve the complications associated with the condition.

If your tricuspid valve regurgitation was from a congenital heart defect, a congenital heart specialist should monitor you and your condition.

If you have mild to moderate tricuspid valve regurgitation, you may only need close monitoring by your doctor.

As the disease progresses, your doctor will recommend more advanced treatment options such as:

Medication

Your physician may recommend various medications to treat the underlying cause of your valve disease to help relieve your tricuspid valve regurgitation symptoms.

Surgical treatment

Surgery may be required to repair or replace your tricuspid valve if symptoms are worsening or your heart is enlarging due to the poor blood flow. Many patients have more than one valve condition, and the doctor may repair all valves in one surgery regardless if they are causing any problems.

Tricuspid surgical valve repair

When possible, surgeons will repair the tricuspid heart valve before replacing it. Repairing the tissue with your own tissue is preferred to avoid long-term complications. Your surgeon may tighten the valve and fix whatever is causing the leakage.

Tricuspid surgical valve replacement

For patients with severe tricuspid valve regurgitation, your surgeon may opt to replace the damaged valve with a new one. During the replacement procedure, your doctor will remove the old valve and replace it with a mechanical or tissue valve (bioprosthetic). There are pros and cons to either option. Your physician will work with you to determine the best valve for you.

After years of use, a bioprosthetic valve may have to be replaced with a new one. This is done in a procedure similar to a balloon valvuloplasty, where a new valve is inserted into the old valve inflated with a balloon and anchored next to the old valve.

Pregnancy with tricuspid valve regurgitation

If you are considering pregnancy and have tricuspid valve regurgitation, consult with your heart and OB physician team before trying to become pregnant. Successful pregnancies are common, but you must be closely monitored by a team of doctors throughout the pregnancy.