Tricuspid valve regurgitation

Overview

Tricuspid valve regurgitation is a type of heart valve disease. The valve between the two right heart chambers doesn't close as it should. Blood flows backward through the valve into the upper right chamber. If you have tricuspid valve regurgitation, less blood flows to the lungs. The heart has to work harder to pump blood.

The condition also may be called:

• Tricuspid regurgitation.
• Tricuspid insufficiency.

Some people are born with heart valve disease that leads to tricuspid regurgitation. This is called congenital heart valve disease. But tricuspid valve regurgitation also may occur later in life due to infections and other health conditions.

Mild tricuspid valve regurgitation may not cause symptoms or require treatment. If the condition is severe and causing symptoms, medicine or surgery may be needed.

Causes

To understand the causes of tricuspid valve regurgitation, it may help to know how the heart and heart valves typically work.

A typical heart has four chambers.

• The two upper chambers, called the atria, receive blood.
• The two lower chambers, called the ventricles, pump blood.

Four valves open and close to keep blood flowing in the correct direction. These heart valves are:

• Aortic valve.
• Mitral valve.
• Tricuspid valve.
• Pulmonary valve.

The tricuspid valve is between the heart's two right chambers. It has three thin flaps of tissue, called cusps or leaflets. These flaps open to let blood move from the upper right chamber to the lower right chamber. The valve flaps then close tightly so blood doesn't flow backward.

In tricuspid valve regurgitation, the tricuspid valve doesn't close tightly. So, blood leaks backward into the upper right heart chamber.

Causes of tricuspid valve regurgitation include:

• A heart condition you're born with, also called a congenital heart defect. Some congenital heart defects affect the shape of the tricuspid valve and how it works. Tricuspid valve regurgitation in children is usually caused by a rare heart condition present at birth called Ebstein anomaly. With this condition, the tricuspid valve does not form as it should. It also is lower than usual in the lower right heart chamber.
• Marfan syndrome. Changes in genes cause this condition. Marfan syndrome affects the fibers that support and anchor the organs and other structures in the body. It's sometimes related to tricuspid valve regurgitation.
• Rheumatic fever. This complication of strep throat can cause lasting damage to the heart and heart valves. When that happens, it's called rheumatic heart valve disease.
• Infection of the lining of the heart and heart valves, called infective endocarditis. This condition can damage the tricuspid valve. IV drug misuse raises the risk of infective endocarditis.
• Carcinoid syndrome. This condition happens when a rare cancerous tumor lets certain chemicals into the bloodstream. It can lead to carcinoid heart disease. This disease damages heart valves, most commonly the tricuspid and pulmonary valves.
• Chest injury. An injury to the chest, such as from a car accident, may cause damage that leads to tricuspid valve regurgitation.
• Pacemaker or other heart device wires. Tricuspid valve regurgitation might happen if wires from a pacemaker or defibrillator cross the tricuspid valve.
• Heart biopsy, also called an endomyocardial biopsy. Heart valve damage can sometimes happen when a small amount of heart muscle tissue is taken out for examination.
• Radiation therapy. Rarely, radiation therapy used to treat cancer in the chest area can cause tricuspid valve regurgitation.

Complications

Tricuspid valve regurgitation complications may depend on how severe the condition is. Possible complications include:

• An irregular and often rapid heartbeat, called atrial fibrillation (AFib). Some people with severe tricuspid valve regurgitation also have this common heart rhythm condition. AFib has been linked to a higher risk of blood clots and stroke.
• Heart failure. In severe tricuspid valve regurgitation, the heart must work harder to pump enough blood to the body. The extra effort causes the lower right heart chamber to get bigger. Untreated, the heart muscle becomes weak. This can cause heart failure. Heart failure is when the heart muscle doesn't pump blood as well as it should.

Treatment

Treatment for tricuspid valve regurgitation depends on the cause and how severe it is. The goals of treatment are to:

• Help the heart work better.
• Reduce symptoms.
• Improve quality of life.
• Prevent complications.

Tricuspid regurgitation treatment may include:

• Medicines.
• A heart procedure.
• Surgery to repair or replace the heart valve.

The exact treatment depends on your symptoms and how severe the valve disease is. Some people with mild tricuspid valve regurgitation only need regular health checkups. Your healthcare team tells you how often you need appointments.

Medications

Your healthcare professional may suggest medicines to control symptoms of tricuspid valve regurgitation. Medicines also may be used to treat the cause of the condition.

Some medicines used for tricuspid valve regurgitation are:

• Diuretics. Often called water pills, these medicines make you urinate more often. This helps prevent fluid buildup in the body.
• Potassium-sparing diuretics. Also called aldosterone antagonists, these medicines may help some people with heart failure live longer.
• Other medicines to treat or control heart failure.
• Medicines to control irregular heartbeats. Some people with tricuspid valve regurgitation have a type of irregular heartbeat called atrial fibrillation (AFib).

Therapies

Those who have pulmonary hypertension with tricuspid valve regurgitation may need supplemental oxygen.

Surgery or other procedures

You may need surgery to repair or replace a diseased or damaged tricuspid valve.

Doctors may do tricuspid valve repair or replacement as open-heart surgery or a surgery with smaller cuts, called minimally invasive surgery. Sometimes, doctors may treat tricuspid valve regurgitation using thin, flexible tubes called a catheters and a balloon or clip.

You may need tricuspid valve repair or replacement surgery if:

• The valve disease is severe and causes symptoms, such as shortness of breath.
• Your heart is getting bigger or weaker, even if you don't have symptoms of tricuspid valve regurgitation.
• You have tricuspid valve regurgitation and need heart surgery for another condition, such as mitral valve disease.

Types of heart valve surgery to treat tricuspid valve regurgitation include:

• Tricuspid valve repair. Surgeons recommend valve repair when possible. It saves the heart valve. It also may reduce the need for long-term use of blood thinners.

  Tricuspid valve repair is typically done as an open-heart surgery. A long cut is made in the center of the chest. A surgeon may patch holes or tears in the valve, or separate or reconnect valve flaps. Sometimes the surgeon removes or reshapes tissue to help the tricuspid valve close more tightly. The surgeon also may replace cords of tissue that support the valve.

  If Ebstein anomaly is the cause of tricuspid regurgitation, heart surgeons may do a type of valve repair called the cone procedure. During this treatment, the surgeon separates the tricuspid valve flaps from the heart muscle. Then the surgeon rotates the flaps and attaches them again.

  If you have severe tricuspid regurgitation and standard repair surgery isn't an option, your healthcare professional may suggest tricuspid transcatheter edge-to-edge repair (T-TEER). This newer treatment uses tubes called catheters and a clip to fix a leaky tricuspid valve. The clip brings the valve flaps closer together so less blood goes backward. Open-heart surgery is not needed for T-TEER. People with tricuspid regurgitation who have this treatment often have fewer symptoms and a better quality of life.

• Tricuspid valve replacement. If the tricuspid valve can't be repaired, surgery may be needed to replace the valve. Surgeons may do tricuspid valve replacement surgery as open-heart surgery or minimally invasive surgery.

  During tricuspid valve replacement, a surgeon removes the damaged or diseased valve. The surgeon replaces the valve with a mechanical valve or a valve made from cow, pig or human heart tissue. A tissue valve is called a biological valve.

  If you have a mechanical valve, you need to take blood thinners for the rest of your life to prevent blood clots. Biological tissue valves don't need lifelong blood thinners. But they can wear down over time and may need to be replaced. Together, you and your care team discuss the risks and benefits of each type of valve to decide which one is best for you.

• Valve-in-valve replacement. If you have a biological tissue tricuspid valve that's no longer working, a catheter treatment may be done instead of open-heart surgery to replace the valve. The doctor inserts a soft tube called a catheter into a blood vessel and guides it to the tricuspid valve. The replacement valve goes through the catheter and into the existing biological valve.

After tricuspid repair or replacement, you need regular health checkups to make sure your heart is working as it should.

Pregnancy

People who have tricuspid valve disease need careful and regular checkups during pregnancy. If you have severe tricuspid valve regurgitation, your care team may tell you not to get pregnant to lower the risk of complications, including heart failure.

Preparing for an appointment

If a healthcare professional thinks you might have tricuspid valve regurgitation, you are usually sent to a doctor trained in heart diseases. This type of doctor is called a cardiologist. If you were born with a heart condition, you may see a type of heart doctor called a congenital cardiologist.

Here's some information to help you get ready for your appointment.

What you can do

• Ask if there is anything you need to do before your appointment. For example, your healthcare professional may tell you not to eat or drink for a short time before a cholesterol test.
• Write down your symptoms, including any that may not seem related to tricuspid valve regurgitation.
• Write down important personal information. This includes a family history of heart valve disease and any major stresses or recent life changes.
• Make a list of all the medicines, vitamins and supplements you take. Include those you bought without a prescription. Also include the doses.
• Take someone with you, if possible. Someone who goes with you can help you remember information you're given.
• Write down questions to ask the healthcare team.

Time with your healthcare professional may be short. Writing down questions before your visit can help you use your time well. For tricuspid valve regurgitation, some basic questions to ask your care team include:

• What's the most likely cause of my symptoms?
• What tests do I need? Do I need to do anything to get ready for them?
• I feel OK. Do I still need treatment?
• What tests do I need?
• What's the best treatment?
• Are there other treatment options?
• I have other health conditions. How can I best manage them together?
• Do I need to change my activities, sports or diet?
• Should I see a specialist?
• If I need heart valve surgery, which surgeon do you recommend?
• Is there any information that I can take home with me?
• What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your healthcare team 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 care team may ask:

• When did you first notice symptoms?
• Do you always have symptoms or do they come and go?
• How severe are your symptoms?
• What, if anything, makes your symptoms better?
• What, if anything, makes your symptoms worse?