Tricuspid Valve Disease

What is tricuspid valve disease?

Tricuspid valve disease is a condition that occurs when the valve between the two right heart chambers doesn’t function properly.

The tricuspid valve is one of four heart valves that help blood flow in the right direction. The tricuspid valve is between the right upper heart chamber (atrium) and the right lower heart chamber (ventricle). Blood flows from the right ventricle to your lungs, where it picks up oxygen for the rest of your body.

If the tricuspid valve doesn’t work properly, you may need monitoring or valve repair or replacement.

What are the different types of tricuspid valve disease?

There are three kinds of tricuspid valve disease:

• Tricuspid atresia: Tricuspid atresia is a birth defect in a baby who has a solid piece of tissue where the tricuspid valve should be. The tissue limits blood flow and can affect the development of the right ventricle. It usually requires surgery.
• Tricuspid regurgitation: Tricuspid valve regurgitation occurs when the valve doesn’t close tightly enough. Blood leaks backward through the tricuspid valve every time the right ventricle contracts. This leakage increases the amount of blood in the atrium. The buildup of blood can enlarge the atrium and change pressure in the heart and blood vessels, potentially causing heart damage.
• Tricuspid stenosis: In this condition, the tricuspid valve opening is too narrow or stiff. This restricts blood flow between the two chambers. Over time, the right atrium can become enlarged, affecting blood flow and pressure. Tricuspid stenosis can reduce the amount of blood that circulates through the lungs and then to the rest of the body.

Problems with the tricuspid valve can occur with other heart valve problems, such as the mitral valve or aortic valve.

What happens if the tricuspid valve fails?

Mild tricuspid valve disease may not cause any symptoms or problems. But moderate to severe cases can enlarge the heart and cause permanent damage over time.

What causes tricuspid valve disease?

Several things can cause tricuspid valve disease, including:

• Carcinoid syndrome.
• Congenital (present at birth) defects, such as Ebstein’s anomaly.
• Enlarged right ventricle.
• Infection, such as rheumatic fever or endocarditis.
• Medications, especially fenfluramine and phentermine (diet drug also known as fen-phen).
• Systemic health conditions, such as lupus, Marfan syndrome or rheumatoid arthritis.
• Pulmonary hypertension.
• Trauma (injury), such as damage from a heart attack, myocardial biopsy or pacemaker
• Tumor or radiation therapy to the chest.

What are the symptoms of tricuspid valve disease?

The signs and symptoms of tricuspid valve disease vary. People with mild cases might have no signs at all. Those with moderate to severe cases might have noticeable tricuspid valve disease symptoms, such as:

• Fatigue or weakness.
• Arrhythmia (abnormal heart rhythm).
• Edema (swelling) in the abdomen (belly), legs, ankles or feet.
• Enlarged liver.
• Heart murmur.
• Pulsing or fluttering feeling in the chest or neck.
• Shortness of breath (dyspnea).
• Skin that feels abnormally cold.

How is tricuspid valve disease diagnosed?

To diagnose tricuspid valve disease, a healthcare provider will conduct a physical exam, which will involve:

• Asking you about your symptoms.
• Discussing your health history and medications.
• Feeling the veins in your neck.
• Listening to your heart with a stethoscope.
• Taking your blood pressure.

If they suspect that you have a heart condition, they may refer you to a cardiologist or order some tests:

• Blood tests.
• Cardiac catheterization(also called cardiac cath or angiogram).
• Chest X-ray.
• Echocardiogram.
• Electrocardiography (EKG).
• Exercise stress test.
• Heart MRI.
• Transesophageal echocardiography.

How is tricuspid valve disease treated?

Based on your test results and symptoms, your healthcare provider will recommend a treatment plan.

You may only need regular appointments and tests to monitor the condition (for example, every six months or once a year).

Your healthcare provider may recommend certain medications to ease the symptoms or prevent complications:

• Anti-arrhythmic medications.
• Angiotensin-converting enzyme (ACE) inhibitors.
• Anticoagulants.
• Digoxin to treat heart failure.
• Diuretics (water pills) to remove extra fluid from the body.

Advanced or severe cases may require tricuspid valve surgery to repair or replace the valve.

How can I prevent a tricuspid valve disorder?

In many cases, you can’t prevent tricuspid valve disease. But if you have a condition that may cause it, seek treatment and follow your healthcare provider’s instructions.

What can I expect if I have tricuspid valve disease?

The outlook with tricuspid valve disease is generally good. Many people manage with regular follow-up appointments and medications. When needed, surgical repair or replacement usually corrects the condition.

But people with severe, untreated cases often have a poor prognosis, including:

• Progressively worse symptoms.
• Ascites.
• Blood clots.
• Cardiac cirrhosis (liver damage caused by heart problems).
• Heart damage.
• Heart failure.

How do I take care of myself with tricuspid valve disease?

People with tricuspid valve disease are at risk for endocarditis (heart valve infection). You should take certain steps to protect yourself:

• Call your doctor if you develop any infection symptoms, such as body aches, fever or sore throat.
• Carry a medical card that identifies you as a person with valve disease in case of emergency medical care.
• Inform all your healthcare providers, including your dentist, that you have valve disease.
• Prevent infections in the teeth and gums, which can travel into the bloodstream to the heart valves. See a dentist regularly, and brush often.
• Ask your cardiologist if you should take antibiotics before procedures that may cause bleeding, including dental work, medical procedures and surgery.

What else should I ask my doctor about tricuspid valve disease?

If you have tricuspid valve disease, consider asking your healthcare provider the following questions:

• What caused this condition?
• Do you think we should monitor the condition, start medications or consider surgery?
• When should I seek emergency medical attention?

A note from Cleveland Clinic

Tricuspid valve disease is a heart condition involving one of the four heart valves. The tricuspid valve may be too stiff or may leak, possibly causing symptoms and heart damage. If you’re experiencing signs like general fatigue, weakness, swelling or fluttering, talk to your primary care provider or a cardiologist. They may recommend monitoring the condition, medication to manage symptoms or surgery to repair or replace the valve.