Tricuspid Valve Insufficiency

Definition

Tricuspid valve insufficiency occurs when a tricuspid valve does not close tightly enough to prevent leakage. This condition is also called tricuspid valve regurgitation and tricuspid incompetence.

Description

The tricuspid valve is located between the right atrium and the right ventricle of the heart. When the right ventricle contracts, it is supposed to pump blood forward into the lungs. If the tricuspid valve does not close tightly, some of that blood leaks back into the right atrium. When the atrium receives its usual quantity of blood from veins leading to the heart, plus the leaking blood, the pressure inside the atrium increases. This higher pressure creates resistance to the flow of blood in the veins that enter the atrium from the body. In addition, this increase in pressure causes the right atrium to enlarge over time. Congestion from fluid buildup occurs, particularly in the liver and legs.

Causes and symptoms

If a person has serious lung disease or a narrowing of the pulmonary valve, the right ventricle must pump harder to force the blood through the pulmonary valve. In order to pump harder, the right ventricle enlarges and the valve opening stretches, causing the valve to leak.

Tricuspid valve insufficiency usually produces such vague symptoms as general weakness and fatigue. As the conditions worsens, a person experiences pain in the upper right part of the abdomen, caused by a congested and enlarged liver. The legs may also swell (edema).

An enlarged right atrium can cause atrial fibrillation (the atria flutters, rather than pumping in a regular rhythm) and severe tricuspid regurgitation of blood, which can eventually lead to congestive heart failure.

Diagnosis

A leaky valve can be heard with a stethoscope; the sound is called a heart murmur. Additional support for diagnosing tricuspid valve insufficiency comes from a medical history, physical exam, and chest x ray. Further testing with echocardiography, to show an image of the leakage and its severity, is the most helpful diagnostic test for this condition.

Treatment

Tricuspid valve insufficiency itself usually does not require treatment, since a tiny leakage occurs in most

normal people. In certain cases, however, if there is underlying pulmonary valve disease or lung disease, those conditions should be treated.

If irregular heart rhythms or heart failure are present, they are usually treated independently of the valve insufficiency.

Since a person with known tricuspid valve insufficiency is at risk for infections of the heart, antibiotics should be taken before and after oral or dental surgery, or urologic procedures.

Prognosis

Tricuspid valve insufficiency is not usually considered to be serious. If it is the result of other cardiopulmonary disease, the extent of those conditions effect the prognosis.

Prevention

In general, tricuspid valve insufficiency cannot be prevented.

BOOKS

McGoon, Michael D., ed. Mayo Clinic Heart Book: The Ultimate Guide to Heart Health. New York: William Morrow and Co., Inc., 1993.

ORGANIZATIONS

American Heart Association. 7320 Greenville Ave. Dallas, TX 75231. (214) 373-6300. <http://www.americanheart.org>.

Dorothy Elinor Stonely

KEY TERMS

Atrial fibrillation—A rapid, uncoordinated quivering of the upper chamber of the heart.

Atrium—The upper chamber of the heart.

Pulmonary valve—The valve at the opening from the right ventricle to the artery that leads to the lungs.