Tricuspid valve regurgitation

Tricuspid regurgitation (TR), or tricuspid valve regurgitation, is a type of heart valve disease that occurs when the valve’s flaps, called cusps or leaflets, don’t close properly. The tricuspid valve controls blood flow from your heart’s right atrium (top chamber) to the right ventricle (bottom chamber). When the valve doesn’t close completely, some blood can leak backward into the atrium, making the heart work harder to move blood through the valve.

TR ranges from mild to severe, and many people live with a mild form for years without needing treatment. At Penn Medicine, our heart valve disease care team monitors your condition closely and recommends treatment when needed, so changes in your condition can be addressed early.

Mild tricuspid regurgitation often causes no symptoms. When symptoms do occur, they may be related to the valve leak, an underlying heart condition, or changes in how well the heart works.

Severe TR may cause:

• Fatigue: Unusual tiredness, especially during physical activity
• Swelling: Noticeable swelling in the abdomen or legs
• Heart palpitations: A racing, pounding, or fluttering heartbeat, sometimes caused by an underlying cardiac arrhythmia
• Pulsing neck veins: A noticeable throbbing or pulsing feeling in the neck
• Shortness of breath: Trouble breathing, especially during physical activity

Severe tricuspid regurgitation can put extra strain on the right side of the heart. Over time, it can contribute to right-sided heart failure and other complications, including an irregular heart rhythm called atrial fibrillation (AFib) and problems caused by fluid buildup.

One of the most common causes 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 outlook will depend on several factors, including your overall health, the cause and severity of your TR, and how well your heart is working. Your care team can help you understand what to expect and how to manage your tricuspid valve regurgitation. You may be asked to:

• Adopt a heart-healthy eating plan
• Quit or avoid smoking and tobacco products
• Stay physically active as recommended by your care team
• Take your medications as prescribed
• Keep regular appointments to monitor your condition
• Maintain good oral health and get regular dental care
• Take antibiotics before certain dental procedures if your care team recommends them to help prevent endocarditis
• Get checked promptly if you think you might have strep throat

Tricuspid regurgitation can have different causes and may affect the heart in different ways. Penn Medicine’s heart valve program brings together interventional cardiologists, cardiac surgeons, and other specialists to treat it. Together, they manage everything from mild disease that may only need monitoring to complex cases that need advanced intervention. Our team also takes part in clinical trials exploring new ways to treat TR. If you’re a candidate, this could mean access to treatments not yet widely available.