A leaky tricuspid valve may make you feel tired and have difficulty exercising. Learn how this type of heart valve disease is diagnosed and treated.
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.
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 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:
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).
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:
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:
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 more muscular right and left ventricles, pump blood out of the heart. The heart valves, which keep blood flowing in the right direction, are gates at the chamber openings.
Several things can increase the risk of tricuspid valve regurgitation, including:
Potential complications of tricuspid valve regurgitation may include:
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.
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 the throat and into the tube connecting the mouth to the stomach (esophagus). Because the esophagus lies close to the heart, this type of echocardiogram provides more information about the heart and heart valves.
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 for tricuspid valve regurgitation depends on the cause and severity of the condition. The goals of treatment are to:
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.
Your health care provider may prescribe medications to control symptoms or to treat an underlying condition that is causing tricuspid regurgitation. Medications may include:
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:
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.
Your health care provider may recommend that you make some lifestyle changes to manage tricuspid valve regurgitation and to improve your heart health, including:
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 conditions (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.
If you have tricuspid valve regurgitation, here are some steps that may help you manage the condition and ease stress or anxiety:
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.
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:
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.
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: