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Tricuspid Regurgitation

(Tricuspid Incompetence; Tricuspid Insufficiency)

By Guy P. Armstrong, MD

Tricuspid regurgitation is leakage of blood backward through the tricuspid valve each time the right ventricle contracts.

  • Tricuspid regurgitation is caused by disorders that enlarge the right ventricle.

  • Symptoms are vague, such as weakness and fatigue.

  • Doctors make the diagnosis because of physical examination findings, and they use echocardiography to confirm the diagnosis.

  • The underlying disorder needs to be treated.

The tricuspid valve is in the opening between the right atrium and the right ventricle. The tricuspid valve opens to allow blood from the right atrium to fill the right ventricle and closes as the right ventricle contracts to pump blood into the lungs. When the tricuspid valve does not close completely, some blood leaks backward into the right atrium, termed regurgitation.

Blood leaking backward into the right atrium increases the volume of blood there and results in less blood being pumped through the heart and to the body. As a result, the right atrium enlarges, and blood pressure increases in the right atrium and the large veins that enter it from the body. The liver and/or legs may swell because of this increased pressure. An extremely enlarged atrium often beats rapidly in an irregular pattern (a disorder called atrial fibrillation), which reduces the heart's pumping efficiency because the fibrillating atrium is quivering rather than pumping. Consequently, blood does not flow through the atrium briskly, and blood clots may form inside the chamber. If a clot breaks loose (becoming an embolus), it is pumped out of the heart and may block an artery, possibly causing a stroke or other damage

Causes

Unlike other heart valve disorders, tricuspid regurgitation usually occurs in a normal valve that has been affected by other heart disorders. The most common cause is when the right ventricle enlarges and resistance to blood flow from the right ventricle to the lungs is increased. Resistance may be increased by .

  • Severe, long-standing lung disorders, such as emphysema or pulmonary hypertension

  • Disorders involving the left side of the heart

  • Narrowing of the pulmonary valve ( pulmonic stenosis), on rare occasions

To compensate, the right ventricle enlarges, stretching the tricuspid valve and causing regurgitation.

Other, less common causes are infection of the heart valves ( infective endocarditis) most often due to intravenous injection of illicit drugs, birth defects of the tricuspid valve, injury, rheumatic fever and weakness of the mitral valve tissue (myxomatous degeneration).

Symptoms

Tricuspid regurgitation usually causes no symptoms except sometimes pulsations in the neck due to the elevated right atrial pressure and discomfort in the right upper part of the abdomen due to an enlarged liver. Rarely, people have accumulation of fluid in the body (edema), mainly in the legs.

Diagnosis

  • Physical examination

  • Echocardiography

The diagnosis is based on the person's medical history and results of a physical examination, electrocardiography (ECG), and chest x-ray. Through a stethoscope, doctors may hear a characteristic murmur produced by the blood leaking backward through the tricuspid valve, but the murmur tends to disappear as the regurgitation worsens.

Echocardiography can produce an image of the leaky valve and show the amount of blood leaking, so that the severity of the regurgitation can be determined.

Treatment

  • Treatment of underlying disorder

  • Sometimes valve repair or replacement

Usually, mild tricuspid regurgitation requires little or no treatment. However, the underlying disorder, such as emphysema, pulmonary hypertension, pulmonic stenosis, or abnormalities of the left side of the heart, is likely to require treatment. Treatment of atrial fibrillation and heart failure is also necessary.

Surgery to repair or replace the tricuspid valve is rarely done unless regurgitation is severe or surgery on another heart valve (for example, mitral valve replacement) is also needed. Surgery may involve sewing in a ring to reduce the size of the valve opening, repairing the valve, or replacing it with a prosthetic valve.

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