Tricuspid Valve Regurgitation

What is tricuspid valve regurgitation?

Tricuspid valve regurgitation is when the “door” connecting the upper and lower chambers on the right side of your heart doesn’t properly close. This leaky door allows some blood to flow backward each time your heart beats. Tricuspid valve regurgitation is a form of heart valve disease. It can range from trivial (no effects on your body) to severe. Over time, moderate to severe backward blood flow through any of your heart valves can make your heart work harder and take a toll on your cardiovascular system.

Other names for this condition include:

• Tricuspid regurgitation.
• Tricuspid insufficiency.
• Leaky tricuspid valve.

What happens during tricuspid valve regurgitation?

To understand this condition, it helps to know a bit about how your tricuspid valve works.

Your tricuspid valve manages blood flow from your right atrium down into your right ventricle (which pushes the blood into your main pulmonary artery). It’s made of a tough, fibrous ring (annulus) that supports three leaflets, or flaps. These leaflets open when your heart relaxes (diastole) to let blood flow from your right atrium into your right ventricle. They close when your heart contracts (systole) to prevent blood from flowing the wrong way, back into your right atrium.

When you have tricuspid valve regurgitation, your leaflets don’t fully seal when your heart contracts. As a result, some of the blood that should get pushed into your pulmonary artery leaks backward into your right atrium. Greater amounts of backward flow lead to more severe valve disease.

Trace, or trivial, tricuspid valve regurgitation (a very small amount of backward flow) is common and harmless, and you won’t feel any symptoms. Mild tricuspid valve regurgitation also causes no symptoms and should have little or no impact on your life. However, your healthcare provider will monitor your condition and may recommend lifestyle changes.

Moderate to severe tricuspid regurgitation is more serious. It may cause symptoms and require treatments ranging from medications to surgery.

Types of tricuspid regurgitation

There are three types of tricuspid regurgitation:

• Primary (organic). This means your tricuspid valve has one or more abnormalities. You may be born with these valve abnormalities (as in Ebstein’s anomaly), or infections or other factors may damage your valve later in life.
• Secondary (functional). With this type, your valve is structurally normal but an underlying medical condition (including various forms of heart disease) causes your valve to malfunction.
• Isolated. This is similar to the secondary type, but it’s when atrial fibrillation is the specific cause of right atrial enlargement. It can also happen due to prior heart surgery or transvenous pacemaker or defibrillator leads. There’s no evidence of additional factors like pulmonary hypertension or left-sided heart disease.

How common is tricuspid valve regurgitation?

Moderate to severe tricuspid regurgitation affects between 5 in 1,000 and 8 in 1,000 people in the U.S.

Many more people have trace (also called trivial) tricuspid valve regurgitation. This means the structure of their valve is usually normal, but a very small amount of blood leaks backward with each heartbeat. Trace regurgitation doesn’t cause any symptoms or lead to complications. But it’s a common finding in advanced imaging tests.

What are the symptoms of tricuspid valve regurgitation?

Trace or mild tricuspid regurgitation causes no symptoms. You may have symptoms with moderate to severe regurgitation, often due to the underlying conditions causing it.

Possible symptoms (things you feel) include:

• Shortness of breath when you’re active.
• Fatigue or weakness that lasts several days or more.
• Swelling (edema) in your belly, ankles or feet, which happens when your heart struggles to do its job.

Signs of tricuspid regurgitation

Possible signs (things your healthcare provider may notice) include:

• A heart murmur, or unusual sounds that indicate abnormal blood flow through your heart valves.
• An unusually strong pulse in your neck or near your liver.

What is the most common cause of tricuspid regurgitation?

Structural changes to the right side of your heart cause most cases of moderate to severe tricuspid regurgitation. Such changes can occur when there’s consistently too much pressure or blood in the right side of your heart. This overworks your right atrium and right ventricle, causing one or both to enlarge.

As one or both of these chambers get bigger, the tough ring (annulus) that supports your tricuspid valve leaflets may grow wider. Healthcare providers call this “annular dilation.” When the annulus is too wide, the leaflets it supports can’t fully come together (coapt).

Also, in some cases, the strong cords of tissue that connect your leaflets to your heart muscle and provide support to the leaflets may become tethered, or limited in their range of motion. These problems prevent your leaflets from closing properly, leading to a leaky valve.

Many different medical conditions can cause your right atrium and/or your right ventricle to enlarge. Examples include:

• Atrial fibrillation.
• Cardiomyopathy.
• Coronary artery disease.
• Failure of your left ventricle.
• Pulmonary hypertension.
• Severe mitral valve regurgitation.
• Severe aortic valve stenosis.

People with tricuspid regurgitation due to an enlarged heart have the “secondary” form of the condition. This means the leaky valve happened because of another medical issue, and the valve’s leaflets are structurally normal.

Less often, tricuspid regurgitation results from abnormal or damaged valve leaflets. Healthcare providers call this form “primary tricuspid regurgitation.” It has many possible causes, ranging from medical conditions to trauma.

Causes of primary tricuspid regurgitation

Factors that can damage your tricuspid valve leaflets, leading to a leaky valve, include:

• Carcinoid syndrome.
• Atrial myxoma.
• Rheumatic heart disease.
• Infective endocarditis.
• Ebstein’s anomaly and other congenital abnormalities.
• Myxomatous degeneration, which means your leaflets become thick and too stretchy and can’t fully seal shut.
• Complications of implanted devices (like pacemakers).
• Radiation therapy to your chest.
• Severe traumatic injury to your chest (from a major car crash, for example).
• Certain medications.

What are the complications of this condition?

Severe tricuspid regurgitation can cause organ damage and lead to:

• Kidney failure.
• Liver failure.
• Right-sided heart failure.

How is tricuspid valve regurgitation diagnosed?

Your healthcare provider will perform a physical exam and order tests as needed to diagnose this condition.

During a physical exam, your provider will use a stethoscope to listen to your heart and breathing. A heart murmur is sometimes detectable during an exam. Your provider may also feel your neck and belly (near your liver). Feeling a strong pulse in either place is a sign of tricuspid regurgitation.

What tests diagnose this condition?

Healthcare providers typically use echocardiography to diagnose tricuspid regurgitation. This test can also identify any valve abnormalities that would indicate the primary form of the condition. Rarely, if an echocardiogram doesn’t provide enough information, providers order a cardiac catheterization.

Other tests your provider may order to find the cause of regurgitation or learn its effects on your body include:

• Blood tests.
• Chest X-ray.
• Electrocardiogram (EKG).
• Cardiac MRI.

What is the treatment for tricuspid regurgitation?

Treatment of tricuspid regurgitation can involve one or more of the following:

• Medications to manage symptoms.
• Medications to treat the underlying causes.
• Heart valve surgery to repair or replace your valve.
• Transcatheter therapies to repair or replace your valve.

Your provider will tailor a treatment plan to your needs, including the severity of the regurgitation and its causes.

Can you prevent tricuspid regurgitation?

It’s not always possible to prevent this condition, which has many possible causes. But you can take some steps to lower your risk.

Many different forms of heart disease can cause tricuspid regurgitation. So, keeping your heart as healthy as possible can help lower your risk of heart diseases that lead to a leaky valve. Here are some tips.

• Follow a heart-healthy eating plan, like the Mediterranean Diet.
• Build up to at least 150 minutes of moderate-intensity exercise per week.
• Avoid all tobacco products.
• Avoid or limit alcohol.
• See a healthcare provider for a yearly check-up.

What can I expect if I have this condition?

The impact on your daily life depends on your condition’s cause and severity. Your healthcare provider is the best person to tell you how this condition may affect your routine. They may recommend you make lifestyle changes or take medications to improve your heart function or overall health. It’s important to follow your provider’s guidance and ask if anything is unclear.

When should I see my healthcare provider?

See your provider for yearly check-ups and go to all of your follow-up appointments. Your provider will tell you how often you need to come in.

Call your provider right away if you have new or worsening symptoms. You should also tell them if any symptoms start to interfere with your usual activities.

When should I go to the ER?

Call 911 or your local emergency number if you:

• Experience symptoms of a heart attack or stroke. These include chest pain, trouble breathing and weakness in one side of your body.
• Fall (especially if you hit your head) while taking blood thinners (anticoagulants or antiplatelet drugs). Blood thinners increase your risk for internal bleeding after a fall.
• Notice signs of infection at your incision site after heart valve surgery. These include swelling, redness or skin that feels hot to the touch.

A note from Cleveland Clinic

Tricuspid valve regurgitation is a medical condition that can affect your daily life greatly or not at all, depending on the severity. Thanks to advances in modern medicine, it’s possible to treat this condition with medications and surgeries. That’s why it’s important to see a healthcare provider regularly. Your provider will keep an eye on your heart health and diagnose any valve problems early, before they can damage your heart or other organs.

If your provider mentions you have trace or trivial tricuspid valve regurgitation, don’t panic. This is common and doesn’t affect your heart function. Your provider will tell you if there’s a reason for concern and what you can do to manage your condition.