Tricuspid regurgitation is a condition divided into four stages based on several factors. Treatment for the condition varies based on the stage and symptoms and may include watchful waiting or, in some cases, surgery.

Tricuspid regurgitation is a type of heart disease that occurs when the tricuspid valve doesn’t close properly. It can cause a backward flow of blood from a section of the heart called the right ventricle to the right atrium.

The American College of Cardiology (ACC) and American Heart Association (AHA) divide tricuspid regurgitation into stages A–D based on:

  • symptoms
  • valve anatomy
  • severity of valve dysfunction

In this article, we examine the stages of tricuspid regurgitation and how treatment varies by stage.

Where is the tricuspid valve?

The tricuspid valve is one of the four valves in the heart. It’s located between the two chambers on the right side of the heart. Tricuspid regurgitation can develop due to issues with the:

  • Tricuspid leaflets: three flaps of tissue that make up the valve
  • Papillary muscles: muscles that contract to close the valve
  • Chordae: small, stringy structures that allow the papillary muscles to pull the valve shut
  • Annulus: the structure that forms the attachment for the three leaflets
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The ACC and AHA guidelines classify tricuspid regurgitation as stage A if people are at risk of tricuspid regurgitation but have no structural heart issues.

Doctors may be able to notice a very small amount of backward flow through the tricuspid valve during a test called transthoracic echocardiography. The structures of the annulus and leaflets are typical.

As many as 85% of people in the general population experience some degree of tricuspid regurgitation, but the majority of people never develop issues.

The ACC and AHA guidelines characterize progressive tricuspid regurgitation (stage B) as a regurgitant volume, or volume of blood flowing backward, of less than 45 milliliters (mL).

With stage B, the annulus may be enlarged, and there might be mild or moderate tethering of the leaflets. Tethering means the leaflets are pulled out of their typical location by the stringy chordae.

People with stage B tricuspid regurgitation don’t have symptoms.

People with stage C have more than a 45 mL regurgitant volume and severe enlargement of the annulus and tethering of the leaflets. The right ventricle and atrium are enlarged.

At this stage, people don’t experience symptoms.

People with stage D tricuspid regurgitation have severe annular enlargement and leaflet tethering. They right ventricle and atrium are also enlarged.

People can experience symptoms of right-sided heart failure.

Symptoms can include:

Transthoracic echocardiography is the primary test that doctors use to measure the stages of tricuspid regurgitation. Other tests a doctor may use to diagnose each stage include:

Here’s a look at how treatment for tricuspid regurgitation varies by stage.

Stage A

Stage A tricuspid regurgitation typically doesn’t require treatment.

Stage B

The ACC and AHA guidelines recommend tricuspid valve surgery for people with stage B disease who are undergoing left-sided valve surgery and have either of the following:

  • enlargement of the annulus greater than 4 centimeters
  • prior symptoms of right-sided heart failure

Stages C and D

People with stage C and D, a more severe form of the disease. may benefit from diuretics to treat fluid build-up.

The ACC and AHA guidelines recommend tricuspid valve surgery for people with stage C or D disease who are undergoing left-sided valve surgery.

According to the guidelines, surgery can help reduce symptoms in people with stage D and symptoms of right-sided heart failure.

A doctor may consider surgery for people with stage C disease and progressive right ventricle enlargement.

People with heart valve disease that develops slowly over the years often don’t have symptoms. If heart valve disease develops quickly, symptoms may include:

Seek medical attention if you develop symptoms of heart valve disease. If you have previously received a tricuspid dysfunction diagnosis, it’s important to go to all your scheduled follow-ups.

Here are some frequently asked questions people have about tricuspid regurgitation.

Does tricuspid valve regurgitation always progress?

Mild tricuspid valve regurgitation often doesn’t progress to a more advanced stage.

In a 2023 study, researchers found that 19% of 1,843 people with at least moderate tricuspid regurgitation experienced progression at a median follow-up of 2.3 years. The progression rates at 1, 2, and 3 years were 4.9%, 10.1%, and 24.8%, respectively.

Should I worry about mild tricuspid regurgitation?

Mild tricuspid regurgitation is very common in the general population and usually doesn’t cause any issues or affect life expectancy.

What is the prognosis for tricuspid regurgitation?

People with mild tricuspid regurgitation often never develop issues.

Severe forms of tricuspid regurgitation may have a poor outlook due to the disease or complications as a result of the underlying cause of the condition.

What is life expectancy with tricuspid regurgitation?

In a 2022 study, researchers found that the overall survival rate for 2,877 people with severe tricuspid dysfunction was 86.3% at 1 year, 76.5% at 3 years, and 70.6% at 5 years.

Tricuspid regurgitation is a condition characterized by the backflow of blood through the tricuspid valve. It can range from mild to severe.

The ACC and AHA’s most recent guidelines divide tricuspid regurgitation into stages A–D. While people with mild disease often don’t develop any issues, people with a severe form of the disease often need surgery.