Tricuspid valve regurgitation

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

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: uou 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.

If left untreated or uncontrolled, someone with severe tricuspid valve regurgitation is also at risk for developing conditions such as heart failure or atrial fibrillation (AFib), a heart rhythm disorder.

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 is leaky and cannot close properly.

Tricuspid 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
• Radiation therapy

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 repair or replacement surgery to correct 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.

Your individual prognosis will depend on many factors including your overall health and disease progression. Your physician can discuss your particular prognosis with you and how best to manage it based on your health and lifestyle goals.

Your care provider may also recommend ways to manage your tricuspid valve regurgitation based on the cause and severity of your disease. You may be asked to:

• Adopt a heart healthy diet
• Quit or avoid smoking
• Maintain a regular exercise routine as advised by your physician; those with heart failure may be asked to limit physical activity to avoid strain on the heart
• Take all medications prescribed by your doctor
• See your doctor regularly for condition monitoring
• Visit the dentist every six months and maintain good oral health. You may need to take antibiotics prior to dental surgery to avoid endocarditis.
• If you suspect you have strep throat, see your doctor right away