What is Tricuspid Valve Disease?

Tricuspid valve disease is a heart condition that affects the flow of blood from the heart’s right atrium to the right ventricle. There are two main types of tricuspid valve disease that cause the valve to work improperly: 

When the tricuspid valve doesn’t close tightly and allows blood to flow backward into the right atrium, it is known as tricuspid valve regurgitation. The most common cause of regurgitation is a prolapsing valve, a condition in which the valve flaps bulge back into the right atrium when the heart contracts. 

When the tricuspid valve flaps become thick, stiff or fused, it is known as tricuspid valve stenosis. This results in a narrowed valve opening and reduced blood flow between the atrium and ventricle.

Baptist Health is known for advanced, superior care for patients with heart problems and the diagnosis, management and treatment of tricuspid valve disease. You will appreciate timely appointments and respectful attention to your concerns, all in a positive and friendly atmosphere. At Baptist Health, you have access to the region’s most comprehensive, multidisciplinary team of specialists and innovative therapies, including many available only through specialized clinical trials. In every way, we work to demonstrate the utmost in excellent care to those who trust us with their health. 

Tricuspid Valve Disease Signs and Symptoms

Tricuspid valve disease may not cause symptoms. When symptoms do occur, they may include: 

• Fatigue or weakness, especially during increased activity
• Heart murmur – an irregular sound heard when blood flows turbulently through the heart
• Heart palpitations – rapid or fluttering heartbeats, which may be felt in the chest or neck
• Chest discomfort 

More serious cases of tricuspid valve disease may show signs of right-side heart failure, such as: 

• Shortness of breath with exertion or when lying flat
• Heavy coughing, sometimes with bloody sputum
• Swollen feet, ankles, and legs
• Cold skin 

Tricuspid Valve Disease Diagnosis

To diagnose tricuspid valve disease, we ask questions about family history and symptoms and do a physical exam. We then use advanced diagnostic procedures and technology to effectively diagnose, inform treatment and carefully monitor the condition. Common diagnostic procedures can include:

Angiogram: A thin tube (catheter) is inserted into a blood vessel and dye is injected to make the blood vessel visible during an X-ray. This can show any blood clots or other blood vessel issues.

Cardiac catheterization: A long, thin flexible tube is threaded through a blood vessel in the arm or groin and to the heart. Contrast material is injected through the tube and a type of X-ray video is taken to show how the heart functions and to look for heart blockages. 

Chest X-ray: A common imaging test of the lungs, heart and aorta.

Echocardiogram: This ultrasound exam uses soundwaves to take moving pictures of the heart’s chambers and valves. 

Electrocardiogram (EKG): This test measures the electrical activity of the heart and can help determine if parts of the heart are enlarged, overworked or damaged. The heart’s electrical currents are detected by 12 to 15 electrodes that are attached to the arms, legs and chest via sticky tape. 

Magnetic resonance imaging (MRI): A large magnet, radio waves and a computer are used to produce pictures of the heart and blood vessels.

Stress testing: This test is conducted during exercise. If a person can't exercise, medicine is given to increase heart rate. Used along with an EKG, the test can show changes to the heart’s rate, rhythm or electrical activity as well as blood pressure. Exercise makes the heart work hard and beat fast while heart tests are administered. 

When diagnosing tricuspid valve stenosis, your doctor may order additional tests to the ones listed above, including:

Transesophageal echocardiography (TEE): A thin tube sent through mouth, down the throat and into the esophagus, near the upper chambers of the heart, produces sound waves for clear pictures of the heart and blood vessels connected to the heart.

Transthoracic Echocardiogram: This ultrasound exam uses soundwaves to take moving pictures of the heart’s chambers and valves.

Tricuspid Valve Disease Causes

While tricuspid valve stenosis is not usually caused by behaviors or lifestyle factors, tricuspid valve regurgitation can be caused by: 

• High blood pressure (particularly pulmonary hypertension)
• Endocarditis
• Heart failure 

Risk Factors

Risk factors that could contribute to tricuspid valve regurgitation or stenosis include: 

Age: By middle age, many people have some tricuspid valve regurgitation caused by natural deterioration of the valve, and may also develop stenosis as a result of calcium deposits building up around the valve.

Autoimmune diseases: In rare cases, conditions such as lupus can lead to tricuspid valve stenosis.

Cardiomyopathy: Certain conditions can cause the heart to work harder, gradually enlarging the right ventricle. This can stretch the tissue around the tricuspid valve, which can lead to leakage.

Certain medications: Prolonged use of certain medications, like some used to treat migraines and other conditions, can cause tricuspid valve regurgitation. 

Chest trauma: Severe trauma, like from a car accident, can lead to tricuspid valve regurgitation.

Congenital heart defects: Some people are born with damaged heart valves. 

Damaged tissue cords: Over time, tissue cords that anchor the flaps of the tricuspid valve to the heart wall may stretch or tear, especially in people with tricuspid valve prolapse. A tear or rupture can cause sudden leakage and may require heart surgery.

Endocarditis: This infection of the heart’s inner lining typically occurs when bacteria from the mouth or elsewhere get into the bloodstream and lodge in the heart. 

Mitral valve disease: Those who have mitral valve disease are also more likely to have tricuspid valve disease. 

Previous heart attack: A heart attack can damage the tricuspid valve and affect its function. 

Radiation therapy: In rare cases, radiation treatments for cancer –focused on the chest – can lead to this condition. 

Rheumatic fever: Late or incomplete treatment of strep throat or scarlet fever can lead to inflammation and infection of the heart’s inner lining, damaging the heart valves. It is a common cause of tricuspid valve stenosis, but fortunately rare in the United States and other developed countries.

Tricuspid valve prolapse: In this condition, the valve flaps and tendon-like cords supporting the valve weaken and stretch so that when the right ventricle contracts, the flaps bulge into the right atrium. This common defect can prevent the tricuspid valve from closing and lead to regurgitation. 

Prevention

While many risk factors cannot be controlled, you can help prevent tricuspid valve regurgitation.

Get enough exercise: Even moderate activity can make a big difference in heart health and help you maintain a healthy weight.

Stop smoking: Smoking can lead to high blood pressure and otherwise damage the heart.

Take medications as prescribed: If you’re on medications to lower cholesterol or blood pressure, continue taking them as directed.

Watch what you eat: Stick to a diet rich in fruit, vegetables and whole grains and low in fat, sugar and salt.

Tricuspid Valve Disease Prognosis

While many who experience some form of tricuspid valve disease never experience symptoms and do not need treatment, those who experience new or worsening symptoms that affect their quality of life may need medication to ease the symptoms, and in some cases surgery to correct the problem. 

Treatment and Recovery

Treatment for tricuspid valve disease depends on the severity of the condition and may include:

Watchful Waiting

Those with few to no symptoms and only minor stenosis or regurgitation may not need treatment, but your physician will likely recommend regular monitoring for any changes in your condition. 

Medication

Common medications to help reduce the symptoms or risk of complications from tricuspid valve disease include:

• Angiotensin-converting enzyme (ACE) inhibitors: These medications lower blood pressure.
• Antiarrhythmics: These medications treat atrial fibrillation or other rhythm disturbances associated with tricuspid valve stenosis.
• Anticoagulants. These medications help prevent blood clots from forming and causing a heart attack or stroke.
• Beta blockers: These medications lower the heart rate and blood pressure.
• Diuretics: These medications remove excess fluid from the body. 

Surgery

Your physician may recommend surgery to treat tricuspid valve regurgitation. Options include: 

• Balloon valvuloplasty: This procedure is used to treat tricuspid valve stenosis. A surgeon guides a catheter tipped with a balloon through a blood vessel in your arm or groin to the narrowed valve. Once in position, the balloon is inflated to widen the valve, improving blood flow.

• Commissurotomy: Balloon valvuloplasty may not work or may not be an option for some cases of tricuspid valve stenosis. In these cases, your surgeon may recommend a type of open-heart surgery called an open commissurotomy to remove calcium deposits and scar tissue to clear the valve’s opening.
• Tricuspid valve repair: Used to treat tricuspid valve regurgitation, a surgeon repairs the valve by reconnecting valve flaps or by removing excess valve tissue so that the flaps can close tightly. The ring around the valve (annulus) may also be tightened or reinforced.
• Tricuspid valve replacement: If your tricuspid valve can't be repaired, your surgeon may replace it with a mechanical or biological valve. Mechanical valves, made from metal, are durable but carry a risk of blood clots. Biological tissue valves — which may come from a pig, cow or human deceased donor — eventually need to be replaced. 

Recovery After Surgery

Your recovery will depend heavily on your condition before the procedure, and the type of procedure performed. Recovery may take anywhere from a few weeks to many months, and you will likely be enrolled in a cardiac rehabilitation program. Your physician will let you know when you can return to work, whether you will need to make any modifications to your daily activities and if you will need to take new medication. 

Complications

Mild tricuspid valve disease may not cause problems, but more severe cases can lead to complications such as:

Atrial fibrillation: This heart rhythm irregularity, in which the upper chambers of the heart beat chaotically and rapidly, can cause blood clots, which can break loose from your heart and travel to other parts of your body. This can lead to a stroke if it cuts off blood supply to the brain.

Heart failure: This occurs when the heart can't pump enough blood to meet the body's needs. 

Heart enlargement: In tricuspid valve stenosis, the right atrium becomes enlarged while the right ventricle remains small. In tricuspid valve regurgitation, both chambers become enlarged. This can lead to a variety of more serious conditions, including heart failure and heart attacks.