Tricuspid Regurgitation (Tricuspid Valve Insufficiency)

Written by Rachel Nall | Published on July 20, 2012
Medically Reviewed by George Krucik, MD

What Is Tricuspid Regurgitation?

In order to understand tricuspid regurgitation (TR), it helps to understand a little about the anatomy of your heart.

Your heart is divided into four sections, called “chambers.” The upper chambers are the left atria and right atria, and the lower chambers are the left ventricle and right ventricle. There is a wall of muscle called the “septum” that separates the right and left sides of the heart.

These chambers are connected. There are openings called “valves” that regulate blood flow both in and out of the heart, and between the chambers. The valves can be thought of like water faucets: they can either open up, allowing blood to flow freely, or close, stopping the flow entirely.

Your tricuspid valve is the valve that separates your right atrium and right ventricle. TR occurs when this valve does not properly close, causing blood to flow back up into the right atrium when the right ventricle contracts. Over time, this condition can weaken your heart.

TR is a fairly rare condition, affecting an estimated 0.9 percent of Americans every year (Mancini, 2011).

Tricuspid regurgitation is also known as “tricuspid valve insufficiency.”

What Causes Tricuspid Regurgitation?

Right Ventricle Dilation

The most common cause of tricuspid regurgitation is right ventricle dilation. The right ventricle (which is the lower right-hand chamber) is responsible for pumping blood from your heart to your lungs. When the right ventricle is forced to work extra-hard at this task, it can dilate (become larger) to compensate. This, in turn, can cause the ring (annulus) of the tricuspid valve to dilate as well. The annulus is a ring of tissue that supports the valve’s ability to open and close.

The enlargement can be a complication of many different disorders, including:

  • emphysema
  • pulmonary hypertension
  • left-side heart disorders
  • pulmonic stenosis (narrowing of the pulmonary valve)

Infection

Infections can directly injure the tricuspid valve, eventually leading to TR. The most common of these infections is infective endocarditis.

Diet Medication Use

Diet medications phentermine and fenfluramine—also known as “Fen-Phen”—have also been linked to tricuspid valve insufficiency. These, however, are now off the market and are not a common cause of TR.

Other Causes

There are other possible causes of TR, all fairly rare, including:

  • certain injuries
  • carcinoid tumors
  • systemic lupus
  • birth defects of the valve
  • Ebstein’s anomaly (a congenital heart disease)
  • tricuspid valve prolapse
  • myxomatous degeneration
  • Marfan syndrome
  • rheumatic fever
  • rheumatoid arthritis

Recognizing the Signs of Tricuspid Regurgitation

Tricuspid valve insufficiency or regurgitation may not cause any recognizable symptoms at first. You are more likely to experience symptoms if you also have pulmonary hypertension or high blood pressure.

Some symptoms of tricuspid valve insufficiency include:

  • abdominal swelling
  • decreased urine output
  • foot and ankle swelling
  • general weakness
  • an irregular heart rhythm
  • swelling in the body
  • pulsing in your neck vein
  • unexplained fatigue

How Is Tricuspid Regurgitation Diagnosed?

Your doctor may suspect TR if you are experiencing symptoms or if you have other diseases known to lead to TR. During your appointment, he or she will begin with a physical examination.

Your doctor will listen to your heart for the presence of a heart murmur. This abnormal heart sound can indicate that blood is flowing backward from the heart valve.

After listening to your heart, your doctor may order some diagnostic tests. These can help to visualize your heart’s valves. You may need to undergo tests such as:

  • electrocardiography
  • chest X-ray
  • echocardiography
  • transesophageal cardiography
  • cardiac catheterization
  • radionuclide scan
  • magnetic resonance imaging (MRI) scan

Treatment Options for Tricuspid Regurgitation

Tricuspid regurgitation does not always need treatment. If your condition is not severe, your doctor may only recommend that you monitor your heart health at regular intervals to ensure the condition does not progress.

If you have an irregular heartbeat, your doctor may prescribe a medication. Tricuspid regurgitation due to heart failure may be treated with medications that strengthen your heartbeat. Swelling can be treated with diuretics to promote the loss of fluids.

It may help to treat any underlying medical conditions, such as high blood pressure, to reduce the symptoms associated with tricuspid valve insufficiency.

In some instances, tricuspid insufficiency will require surgical repair. Surgeons also can replace the tricuspid valve.

Potential Long-Term Complications

If left untreated, tricuspid regurgitation can increase your risk of heart failure. It may also lead to weight loss, appetite loss, and cirrhosis of the liver.

Those with tricuspid regurgitation are at a greater risk for endocarditis, an infection of the heart. If you have a problem with your tricuspid valve, it is important to take steps to reduce your risk of endocarditis. You should:

  • take good care of your teeth and gums
  • tell all your doctors and dentists that you have a valve disease
  • take antibiotics to prevent infection before any invasive medical procedure or dental work
  • alert your doctor if you experience symptoms of an infection, such as fever, sore throat, and body aches
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