Tricuspid valve regurgitation

Symptoms & causes Diagnosis & treatment Doctors & departments Care at Vejthani

Overview

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

When valve between the right ventricle and right atrium doesn’t close completely, it results in a condition known as tricuspid valve regurgitation resulting in the blood flowing backwards into the upper right chamber (right atrium).

The tricuspid valve may regurgitate at birth (congenital heart disease). Tricuspid valve regurgitation can occasionally be the outcome of valve issues brought on by other medical diseases.

Mild tricuspid valve regurgitation may have no symptoms and therefore may not require treatment. Medication or surgery may be required if the problem is severe and symptomatic.

Symptoms

The signs and symptoms of tricuspid valve regurgitation frequently do not appear until the condition is severe. When testing are performed for other purposes, the condition can be found.

Tricuspid valve regurgitation symptoms and signs can include:

Heart arrhythmias
Heart murmur
Fatigue
Difficulty of breathing when doing activity
Neck pulsation
Abdomen, legs or neck vein swelling

If you experience easily being exhausted or shortness of breath during activities, schedule a consultation with a doctor. Your doctor could suggest that you see a specialist in heart issues (cardiologist).

Causes

Knowing how the heart and heart valves normally function may be useful in understanding the reasons of tricuspid valve regurgitation.

Hearts have four chambers. Blood is filled into the two upper chambers (atria) and blood is pumped by the two lower chambers (ventricles). To maintain proper blood flow, four valves open and close continuously. The heart is made up of 4 valves, which are the aortic valve, mitral valve, tricuspid valve, and pulmonary valve.

The two right heart chambers are separated by the tricuspid valve. Three tiny tissue flaps (called cusps, or leaflets) make up the tricuspid valve. The right atrium’s upper chamber (right atrium) and lower chamber (right ventricle) blood flow is enabled by these valve flaps opening. After that, the valve flaps seal firmly to stop the flow of blood backward.

The tricuspid valve does not seal tightly in tricuspid valve regurgitation and therefore causes blood to seep into the right atrium as a result.

Causes of tricuspid valve regurgitation include:

Congenital heart defects. The tricuspid valve’s structure and function can be impacted by congenital cardiac abnormalities. The unusual congenital heart defect known as Ebstein anomaly frequently results in the regurgitation of the tricuspid valve in young children. The tricuspid valve is deformed in this condition and rests lower in the right ventricle than it should.
Genetic disorders. A connective tissue condition called Marfan syndrome sporadically results in tricuspid valve regurgitation.
Rheumatic fever. Untreated strep throat can have complications that harm other heart valves, including the tricuspid valve, leading to valve regurgitation later in life.
Infective endocarditis. Tricuspid valve damage can result from an infection of the heart’s lining.
Carcinoid syndrome. A hormone-like substance that can harm heart valves, most frequently the tricuspid valve and pulmonary valves, is produced by tumors that start in the digestive system and spread to the liver or lymph nodes in this uncommon illness.
Chest trauma. Tricuspid valve regurgitation may result from chest trauma, such as that sustained in a vehicle collision.
Pacemaker or cardiac device wires. When pacemaker and defibrillator wires, which cross the tricuspid valve, are inserted or removed, it might occasionally result in tricuspid valve regurgitation.
Heart muscle (endomyocardial) biopsy. A tiny sample of cardiac muscle tissue is taken during this procedure and examined for indicators of inflammation or infection. Occasionally, this biopsy can result in valve damage.
Radiation therapy. Tricuspid valve damage and regurgitation may result after receiving radiation to the chest, such as during cancer treatment.
Myxomatous degeneration. This occurs when the valve’s leaflets get too stretched and are unable to seal. Although it occurs more frequently in the mitral valve, there is a possibility of occurrence in the tricuspid.

Risk factors

Tricuspid valve regurgitation is made more likely by a number of factors, including:

Heart attack
Heart failure
Hypertension
Pulmonary hypertension
Chest exposure to radiation
Cardiomyopathy (weakened heart muscle)
Heart-related infections such rheumatic fever and infective endocarditis
Heart defects present since birth such as Ebstein anomaly
Making use of some stimulants and drugs for migraines and Parkinson’s disease

Diagnosis

Silent regurgitation of the tricuspid valve is possible. The problem in children might not be diagnosed until later in life. When imaging studies of the heart are performed for various purposes, tricuspid valve regurgitation may be found.

Tests

A number of tests may be carried out to confirm the diagnosis and the cause and severity of your tricuspid valve regurgitation.

Testing outcomes may assist your doctor in creating a suitable treatment strategy.

The following tests may be used to identify tricuspid valve regurgitation:

Echocardiogram. Is the primary test for identifying tricuspid valve regurgitation. Sound waves are used in an echocardiography to provide finely detailed images of the beating heart. The test can reveal the tricuspid valve’s anatomy, as well as the flow of blood through the various heart regions and heart valves.

An instrument called a transducer, is softly dragged across the skin on the chest during a transthoracic echocardiography, provides images of the heart. Your doctor can suggest a transesophageal echocardiography if more precise images are required. A flexible tube with a transducer inside is inserted during this procedure into the tube that connects the mouth to the stomach and down the throat (esophagus). Due to the proximity of the esophagus to the heart, this kind of echocardiography reveals additional details about the heart and heart valves.

Cardiac MRI. Radio waves and magnetic fields can be utilized to produce specific images of your heart. A cardiac MRI assesses the size and functionality of the lower right heart chamber (right ventricle) as well as the severity of tricuspid valve regurgitation.
Electrocardiogram (ECG or EKG). The electrical activity of the heart is measured by this rapid and painless examination. Electrodes are applied to the chest, and occasionally the arms, legs in the form of sticky patches. The electrodes are connected by wires to a computer, which shows the test findings.
Chest X-ray. The health of the heart and lungs can be seen on a chest X-ray.
Exercise stress test. This kind of test is used to demonstrate how the heart responds to physical exertion. The heart rhythm, blood pressure, and respiration are all monitored when you walk on a treadmill or cycle a stationary bike.
Cardiac catheterization. Rarely, cardiac catheterization may be used to identify specific tricuspid valve regurgitation causes and to aid in treatment selection.

In this procedure, a physician uses X-ray imaging to guide a long, thin tube (catheter) into a blood vessel, typically in the groin. Through the catheter, a particular dye is given to demonstrate blood flow through the heart’s blood vessels and valves.

Treatment

The origin and severity of tricuspid valve regurgitation determines the appropriate course of treatment. The objectives of treatment targets to manage the signs and symptoms, decrease the complications and enhance the quality of life.

If your tricuspid valve regurgitation is mild, you might not require routine follow-ups. You may require routine consultations to monitor your condition if your regurgitation is more severe.

You may require medication, a catheter treatment, or surgery to repair or replace the valve if you have tricuspid valve disease as a result of an underlying disorder or congenital heart problem.

Medications

To address an underlying problem that is producing tricuspid regurgitation or to control symptoms, your doctor may prescribe medication to eliminate excess body fluid (diuretics), regulate heart rhythm (anti-arrhythmics), and manage heart failure.

Surgery or other procedures

Surgery may be required in some cases of tricuspid valve regurgitation to replace or repair the valve. Open heart surgery or minimally invasive cardiac surgery are both options for valve repair or replacement. Occasionally, a catheter-based technique may be used to treat tricuspid valve issues.

A doctor may advise tricuspid valve surgery to replace or repair it if:

You have symptoms or signs of severe tricuspid valve regurgitation.
You have cardiac enlargement, with or without symptoms.
You require heart surgery for another illness, such as mitral valve disease, and you also have tricuspid valve regurgitation.

Tricuspid valve regurgitation is treated surgically or through other means as follows:

Tricuspid valve repair. Repairing the tricuspid valve helps maintain cardiac function and may lessen the need for chronic blood thinner treatment.

Repairing the tricuspid valve typically involves open cardiac surgery. The valve may need to be repaired by reinforcing holes or tears, reshaping or removing tissue to assist the valve shut more tightly, splitting valve leaflets, or strengthening the valve base or roots.

Repairing the Ebstein anomaly, a congenital cardiac condition, is treated using the cone procedure, a type of valve replacement surgery. The leaflets that close off the tricuspid valve are separated from the underlying heart muscle by the cardiac surgeon. After that, the leaflets are turned and reattached.

Tricuspid valve replacement. The surgeon may remove the diseased or damaged tricuspid valve and replace it with a mechanical valve or a valve manufactured from cow, pig, or human heart tissue (biological tissue valve) if the tricuspid valve cannot be repaired.

You will require lifelong blood-thinning medicine if you have a mechanical valve in order to prevent blood clots. Biological tissue valves, however, can degrade over time and frequently require replacement. To choose the best heart valve for you, you and your healthcare professional can jointly analyze the advantages and disadvantages of each type.

Catheter procedure. A catheter method may be used to replace a biological tissue tricuspid valve in place of open cardiac surgery if it is no longer functional. Using X-rays as a guide, the doctor places a thin, hollow tube (catheter) into a vein and directs it to the tricuspid valve. A catheter is used to insert the replacement valve into the biological valve that is already there.
Other procedures. A treatment known as the “maze procedure” or catheter ablation may be used to stop the incorrect heart impulses that cause irregular heartbeats if tricuspid valve regurgitation is the cause of heart rhythm issues (arrhythmias).

Diseases & Conditions Tricuspid valve regurgitation