Tricuspid Valve Regurgitation

Overview

What is tricuspid valve regurgitation?

Tricuspid valve regurgitation happens when the tricuspid valve in your heart doesn't seal shut entirely. This allows blood to flow backward, and the more backward blood flow, the more severe it is. Over time, this can change the structure or shape of your heart and lead to permanent heart damage and a variety of other problems. The full name is often shortened to “tricuspid regurgitation.”

Where is the tricuspid valve?

The tricuspid valve is between the right atrium (upper chamber) and right ventricle (lower chamber) in your heart. It’s the first valve (out of four) that blood passes through after circulating through your body.

How common is tricuspid valve regurgitation?

Trace amounts of tricuspid regurgitation are found in about 50% to 60% of young adults. Mild tricuspid regurgitation happens in about 15% of adults. At least 1.6 million people in the U.S. have moderate or severe cases. Worldwide, it’s estimated that there are about 70 million people with tricuspid regurgitation.

Is tricuspid regurgitation normal?

While tricuspid regurgitation is common in adults, it's not considered normal. However, trace regurgitation isn't harmful.

How does tricuspid valve regurgitation affect my body?

At its lowest levels, tricuspid regurgitation doesn't seem to affect your body. However, as the condition becomes more severe, so do the effects. Moderate and severe tricuspid regurgitation can change the shape of your heart. This can cause permanent heart damage, leading to heart failure and death (especially in those over 70).

Symptoms and Causes

What are the symptoms of tricuspid valve regurgitation?

Symptoms of tricuspid regurgitation might not stand out when another condition or disease is the real problem. It’s also common for there to be no symptoms with trace and mild tricuspid regurgitation.

Symptoms of tricuspid regurgitation include:

  • Shortness of breath. This usually happens when you're active.
  • Fatigue or weakness. This is when you feel exhausted for an extended period (days or more), well beyond just feeling tired.
  • Swelling in your abdomen, ankles or feet. This kind of swelling happens when your heart struggles to do its job, causing too much fluid to build up. Swelling in your abdomen may also be a sign that your liver is getting too much blood flow, which can cause it to swell and not work correctly. This can cause jaundice (yellowing of the skin or whites of your eyes) and weight loss.
  • Heart murmur. A healthcare provider with a stethoscope listening to your heart sounds can usually hear a murmur. Murmurs are unusual sounds that indicate a part of your heart isn’t functioning correctly.
  • Unusually strong pulse. Your provider may be able to feel an unusually strong pulse in your neck or near your liver. This usually happens with severe and advanced cases of tricuspid regurgitation.

What causes tricuspid valve regurgitation?

Each valve inside your heart has flaps (called leaflets) for blood to pass through. Regurgitation happens when the leaflets don’t seal completely shut, letting blood flow backward. The more blood that flows backward, the worse the regurgitation.

There are two types of tricuspid regurgitation.

  • Functional: Also called secondary tricuspid regurgitation. This type of tricuspid regurgitation happens because of another disease or condition. This is the most common type and it’s often found when diagnosing other diseases.
  • Organic: Also known as primary tricuspid regurgitation, this type isn’t caused by another disease or condition.

Tricuspid regurgitation is a form of tricuspid valve disease. The other form of this disease is tricuspid stenosis (narrowing or blockage of the valve) and they can occasionally happen at the same time.

What are some of the diseases that cause or happen along with tricuspid regurgitation?

Diseases or conditions that can cause tricuspid regurgitation include:

  • Bacterial infections. Untreated bacterial infections can cause rheumatic fever, which damages the leaflets of your heart’s valves. When regurgitation and stenosis of the tricuspid valve are both found, it’s almost always for this reason.
  • Ebstein’s anomaly. People born with this rare defect have a tricuspid valve that isn’t formed correctly and the right atrium (upper chamber) of their heart is too large. Milder cases can go unnoticed until a person is an adult.
  • Connective tissue disorders. Genetic diseases like Marfan syndrome and rheumatoid arthritis are strongly connected to tricuspid regurgitation.
  • Carcinoid tumors. This is an uncommon type of cancer that tends to grow slowly and usually starts somewhere in your digestive system. It can sometimes cause tissue to build up inside your heart, interfering with blood flow.
  • Endocarditis. This is an inflammation of the inside of your heart caused by infections. You're at higher risk if you need regular dialysis or have a permanent port implanted for intravenous (IV) medications. It's also more common if you have a history of IV drug use.
  • Myxomatous degeneration. This happens when the valve's leaflets become too stretchy, which stops them from sealing. While it’s more common in the mitral valve, it can also happen to the tricuspid valve.
  • Other heart valve diseases or conditions. Any disease or condition that affects blood flow through the heart may lead to tricuspid regurgitation. This includes heart attack and heart rhythm problems, especially those that cause pulmonary hypertension (high blood pressure in your lungs).

Other causes of tricuspid regurgitation include:

  • Injury. In rare cases, injury to your chest can damage your tricuspid valve. The injury is usually severe, such as with falling from a high place or a major car crash.
  • Implanted devices. Pacemakers and similar devices may cause tricuspid regurgitation. This usually happens because of a dislodged wire that ends up in the wrong place.
  • Radiation therapy. Radiation therapy for certain cancers can sometimes damage the tricuspid valve.
  • Medications. Some medicines can damage your heart and cause tricuspid regurgitation.

Diagnosis and Tests

How is tricuspid valve regurgitation diagnosed?

Several tests can help diagnose tricuspid regurgitation, either on its own or in connection with another disease or condition. Your primary care provider or a cardiology specialist may do one or more of the following:

  • Physical exam. This will include listening to your heart and breathing sounds. A heart murmur is an easily detectable sign during a physical exam. They may also feel your neck and abdomen near your liver. Feeling a strong pulse in either place is a symptom of tricuspid regurgitation.
  • Electrocardiogram (ECG or EKG). This test uses sensors placed on the skin of your chest to measure the electrical activity of your heart. It can detect subtle changes in how your heart beats, as well as other heart problems that can cause tricuspid regurgitation.
  • Chest X-ray. An X-ray can often show a healthcare provider changes in the structure of your heart caused by tricuspid regurgitation.
  • Echocardiogram. Using ultrasound waves, a provider can see your heart and the chambers and valves inside it. They can also see blood flowing backward inside your heart and measure the severity of the problem.
  • Cardiac catheterization. A small device is inserted into one of the arteries in your body, usually in your arm or near your groin, and then threaded up to your heart. This lets healthcare providers see and diagnose problems from inside your heart.
  • Blood tests. Tricuspid regurgitation can have negative effects on your liver, which certain blood tests can detect.

Management and Treatment

Is there a cure for tricuspid valve regurgitation?

It’s sometimes possible to cure tricuspid regurgitation, depending on how severe the case is and what caused it. Repairing or replacing the valve is the most common solution. When another disease (especially heart conditions) is the cause, treating the main disease may stop the regurgitation.

In cases where you're born with tricuspid regurgitation, it isn't possible to cure it. If a genetic disease causes it, it may be possible to treat related symptoms but the disease that causes the regurgitation isn’t curable.

Milder cases of tricuspid regurgitation may not have any symptoms, and many people live years without symptoms. In severe and advanced cases, it's usually not possible to cure tricuspid regurgitation, but you can usually manage the symptoms.

How is tricuspid valve regurgitation treated?

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

  • Medication: Medication can control many of the symptoms of tricuspid regurgitation. Symptoms include high blood pressure, swelling in your abdomen or limbs, and abnormal heart rhythms (arrhythmias).
    • Sometimes connected to tricuspid regurgitation is atrial fibrillation, an abnormal rhythm in one or both of the upper chambers of your heart. Atrial fibrillation increases your risk of forming a blood clot that can cause a stroke or pulmonary embolism. Your healthcare provider may prescribe a blood thinner to prevent clots from forming.
  • Valve repair. This kind of repair is done in one of two ways:
    • Surgically: A surgeon will make an incision in your chest, directly access your heart and repair the tricuspid valve. This can be done through smaller incisions using minimally invasive techniques or robot-assisted surgery. Robotic-assisted surgery has a surgeon “drive” the robot, allowing them to see and operate without the need for larger incisions. Smaller incisions hurt less and the recovery time is shorter.
    • Catheter-based procedure: Similar to the cardiac catheterization diagnostic approach mentioned above, an interventional cardiologist can use a similar method to repair the valve. A relatively new way to do this involves a type of clip that attaches to the valve's leaflets, which helps them seal correctly. The catheter is passed to your heart via the vein at the top of your thigh.
  • Valve replacement. Replacing the tricuspid valve can also be done in one of two ways:
    • Surgically: Similar to the repair mentioned above, the difference is that a surgeon will replace the valve instead of repair it. Valves used to repair it can be biological (from humans, pigs or cows), mechanical, or a combination of the two.
    • Catheter-based procedure: Also similar to the catheter-based procedures mentioned before, this method also accesses your heart via the vein at the top of the thigh. Once inside, a new valve is placed.

In general, the preferred approach for most patients is valve repair because it has fewer risks than valve replacement. Your healthcare provider will explain your options and help you understand which is most likely to give you the best outcome.

How long does it take to recover from tricuspid valve repair or replacement?

Recovery time from valve repair or replacement depends on the method used.

  • Surgery: Valve repair or replacement done with surgery usually involves a hospital stay of a few days. The total time to recover is generally several weeks.
  • Catheter-based procedures: Most people who have catheter-based procedures can go home the same day or the next day. Most can get back to their regular routine shortly afterward.

Prevention

Can tricuspid valve regurgitation be prevented?

For the most part, the only way to prevent tricuspid regurgitation is to treat bacterial infections quickly and effectively. Rheumatic fever and its impacts on your heart are almost always preventable with antibiotic treatment.

Outlook / Prognosis

What can I expect if I have tricuspid regurgitation?

What you should expect with tricuspid regurgitation depends on what caused it and how severe your case is. In general, the worse your case is, the more significant the impact on your life. Your healthcare provider can help you better understand your case. This includes what you can expect, what kind of treatment and follow-up care are needed.

How can I manage symptoms of tricuspid valve regurgitation?

How you manage your tricuspid regurgitation will depend on how severe it is and what caused it in the first place.

  • Trace regurgitation: You will likely have no changes in your life because of this level of regurgitation.
  • Mild regurgitation: This level of regurgitation should have little or no impact on your life. Your healthcare provider may advise you to make changes to your diet.
  • Moderate or severe regurgitation: Your healthcare provider may advise you to change your diet. For severe cases, especially those with heart failure, your provider may recommend you limit physical activity. This is to keep the strain on your heart to a minimum.

When should I call my healthcare provider?

You should call your healthcare provider if you have any tricuspid regurgitation symptoms that worsen suddenly or that start to interfere with your life and normal activities.

When should I go to the emergency room?

You should always go to the hospital for the following symptoms:

If you are on a new medication for tricuspid regurgitation, you should go to the emergency room in the following situations:

  • Unexpected side effects. Your healthcare provider can tell you what kind of side effects to expect and how they’re likely to affect you. Your provider can also tell you which side effects need immediate medical attention.
  • After a fall. If you fall — especially if you hit your head — while on blood thinners. Blood thinners significantly increase your risk for internal bleeding after a fall.

If you had surgery or catheter-based valve repair or replacement, you should go to the hospital in the following situations:

  • If you have any signs of infection at the site of an incision. These include swelling, redness or the incision site feeling hot to the touch.
  • If you have any signs of a heart attack or stroke, especially the ones listed at the beginning of this section.
  • If you’re taking blood thinners and have a fall or injury, for the same reasons described immediately above.

A note from Cleveland Clinic
Tricuspid valve regurgitation is a medical condition that can affect your daily life, depending on the severity. Thanks to advances in technology and modern medicine’s understanding of the heart’s function, it’s possible to treat or even cure this condition. Even when it’s not curable, your healthcare provider can help you treat and manage it to help keep it from interfering with your daily activities.

Last reviewed by a Cleveland Clinic medical professional on 07/26/2021.

References

  • Bishop MA, Borsody K. Percutaneous Tricuspid Valve Repair. (https://www.ncbi.nlm.nih.gov/books/NBK564430/) [Updated 2021 Mar 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Accessed 7/6/2021.
  • Bush CA. Hemodynamics: Normal and Valvular Heart Disease. (https://accesscardiology.mhmedical.com/content.aspx?bookid=2372&sectionid=185598424) In: Baliga RR, Lilly SM, Abraham WT. eds. Color Atlas and Synopsis of Interventional Cardiology. Chapter 1. McGraw Hill; Accessed 7/2/2021.
  • Chikwe JY, Castillo JG. TRICUSPID AND PULMONARY VALVE DISEASE. (https://accesscardiology.mhmedical.com/content.aspx?bookid=2046&sectionid=176557887) In: Fuster V, Harrington RA, Narula J, Eapen ZJ. eds. Hurst's The Heart, 14e. Chapter 51. McGraw Hill; Accessed 7/2/2021.
  • Cosyns B, Droogmans S, Rosenhek R, Lancellotti P. Drug-induced valvular heart disease. (https://heart.bmj.com/content/99/1/7.short) Heart. 2013 Jan 1;99(1):7-12. Accessed 7/6/2021.
  • He Y, Guo Y, Li Z, et al. Echocardiographic determination of the prevalence of primary myxomatous degeneration of the cardiac valves. (https://www.sciencedirect.com/science/article/pii/S0894731711000022?via%3Dihub) J Am Soc Echocardiogr. 2011;24(4):399-404. doi:10.1016/j.echo.2011.01.001.
  • Marwick TH, DeMaria AN, Blanchard DG, et al. ECHOCARDIOGRAPHY. (https://accesscardiology.mhmedical.com/content.aspx?bookid=2046&sectionid=176551421) In: Fuster V, Harrington RA, Narula J, Eapen ZJ. eds. Hurst's The Heart, 14e. Chapter 15. McGraw Hill; Accessed 7/2/2021.
  • Mehrotra D, Dalley P, Mahon B. Tricuspid valve avulsion after blunt chest trauma. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3461659/) Tex Heart Inst J. 2012;39(5):668-670. Accessed 7/6/2021.
  • Nath J, Foster E, Heidenreich PA. Impact of tricuspid regurgitation on long-term survival. (https://www.jacc.org/doi/full/10.1016/j.jacc.2003.09.036) J Am Coll Cardiol. 2004;43(3):405-409. Accessed 7/2/2021.
  • Taramasso M, Vanermen H, Maisano F, Guidotti A, La Canna G, Alfieri O. The growing clinical importance of secondary tricuspid regurgitation. (https://www.sciencedirect.com/science/article/pii/S0735109711050984?via%3Dihub) J Am Coll Cardiol. 2012;59(8):703-710. Accessed 7/2/2021.
  • U.S. National Library of Medicine. Tricuspid regurgitation. (https://medlineplus.gov/ency/article/000169.htm) Accessed 7/2/2021.

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy