Tricuspid Valve Disease

The tricuspid valve separates the right ventricle (upper heart chamber) from the right atrium (lower heart chamber). The two common types of tricuspid valve diseases are tricuspid insufficiency/tricuspid regurgitation and tricuspid stenosis.

Tricuspid insufficiency/tricuspid regurgitation is a disorder involving backward flow of blood across the tricuspid valve.

This occurs during contraction of the right ventricle and is caused by damage to the tricuspid heart valve or enlargement of the right ventricle.

Risk factors

The most common cause of tricuspid regurgitation is not damage to the valve itself but enlargement of the right ventricle, which may be a complication of any disorder that causes failure of the right ventricle.

Rheumatic fever, diet medications such as "Phen-fen" (phentermine and fenfluramine) or dexfenfluramine, and a congenital heart disease (Ebstein anomaly) are among the risk factors for tricuspid regurgitation. Rarely, tricuspid regurgitation is caused by an unusual tumor called carcinoid which secretes a hormone which damages the valve. Other infrequent causes of tricuspid regurgitation include endocarditis, rheumatoid arthritis, radiation therapy, Marfan syndrome, and injury.

Symptoms

In the absence of high blood pressure in the lungs (pulmonary hypertension), tricuspid regurgitation is usually asymptomatic. If pulmonary hypertension and moderate–to–severe tricuspid regurgitation coexist, symptoms may include:

• active neck vein pulsations

• decreased urine output

• fatigue, tiredness

• generalized swelling

• swelling of the abdomen

• swelling of the feet and ankles

• weakness

Prevention

Steps to prevent or to reduce the risk of tricuspid regurgitation include:

• telling your health care provider or dentist if you have a family history of  heart valve disease or any family history of congenital heart diseases before treatment 

• obtaining prompt treatment for conditions that may cause valve disease

• treating strep infections promptly to prevent rheumatic fever

Diagnostic Tools

Many tests are used to diagnose tricuspid valve disease. Usually, more than one test is done before a definitive diagnosis can be made. Some of the tests may include:

• physical examination and patient history   

• ECG 

• chest X–ray  

• echocardiogram 

• cardiac catheterization and coronary angiography  

• cardiac CT angiography

Treatment Options

Heart valve surgery can be used to replace or repair damaged tricuspid valves.

Tricuspid valve repair surgery corrects tricuspid insufficiency; the damaged valve is strengthened and shortened to help the valve close more tightly. Tricuspid valve replacement surgery corrects both tricuspid stenosis and insufficiency 

Surgeons may consider replacing the original valve with either:

• Mechanical valves created from manmade materials.

• Biological (tissue) valves