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What Is Tricuspid Valve Regurgitation?

The tricuspid valve controls the flow of blood from your heart’s right atrium (top chamber) to the right ventricle (bottom chamber). Tricuspid regurgitation occurs when the valve’s flaps (cusps or leaflets) do not close properly. Blood can leak backward into the atrium, causing your heart to pump harder to move blood through the valve.

The most common cause of tricuspid regurgitation is enlargement of the right ventricle. Pressure from heart conditions, such as heart failure, pulmonary hypertension and cardiomyopathy, cause the ventricle to expand. The result is a misshapen tricuspid valve that cannot close properly.

Regurgitation can also develop as a result of:

  • Infection, such as infective endocarditis or rheumatic fever
  • Congenital heart disease, such as Ebstein anomaly
  • Carcinoid syndrome
  • Injury caused during the placement or removal of implantable device wires, such as pacemaker wires
  • Endomyocardial biopsy
  • Chest trauma
  • Marfan syndrome

Tricuspid Regurgitation Symptoms

You may not notice any symptoms of tricuspid regurgitation until the condition is severe. Often, the first signs are symptoms of the underlying condition causing the regurgitation. Symptoms of severe tricuspid regurgitation include:

  • Fatigue: You may feel unusually tired, especially during physical activity.
  • Swelling: You may have noticeable swelling in your abdomen, legs or neck veins.
  • Abnormal heart rhythms: Cardiac arrhythmia may feel like your heart is beating too slowly, too quickly or irregularly.
  • Pulsing in your neck: You may notice pronounced throbbing in your neck veins.
  • Shortness of breath: You may have trouble breathing deeply, especially during exercise.

Diagnosing Tricuspid Regurgitation

Even if you are not symptomatic, your doctor may diagnose mild regurgitation while testing for other conditions. If you are showing signs of a leaky valve, your cardiologist will use advanced echocardiography and cardiovascular imaging techniques including:

  • Transthoracic echocardiogram (TTE)
  • Transesophageal echocardiogram (TEE)
  • Cardiac magnetic resonance imaging (MRI)
  • Electrocardiogram (ECG) (may monitor heart during exertion)
  • Chest X-ray
  • Heart catheterization

Tricuspid Regurgitation Treatment at Penn Medicine

Your tricuspid valve only requires repair or replacement if the regurgitation or your symptoms are severe. Depending on the severity of your tricuspid regurgitation, treatment at Penn may include:

  • Regular monitoring: Our cardiac team and expert imaging professionals monitor your disease progression during regular appointments.
  • Medication: To address any uncomfortable symptoms, such as swelling or irregular heart rhythms, your doctor may prescribe medication. Medications for tricuspid regurgitation typically help to prevent water retention and control your heart rate.
  • Surgery: Your doctor may recommend tricuspid valve surgery to repair or replace your diseased valve. If you are having surgery for another heart condition, your tricuspid valve may be treated during the same procedure.

In addition to traditional treatments, Penn interventional cardiologists participate in many clinical trials testing innovative transcatheter devices developed to treat tricuspid valves. Select patients are candidates for investigational devices and procedures.

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