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Tricuspid regurgitation

Definition

Tricuspid regurgitation is a disorder in which the heart's tricuspid valve does not close properly, causing blood to flow backward (leak) into the right upper heart chamber (atrium) when the right lower heart chamber (ventricle) contracts.

Alternative Names

Tricuspid insufficiency

Causes, incidence, and risk factors

The tricuspid valve separates the right lower heart chamber (the right ventricle) from the right upper heart chamber (right atrium).

The most common cause of tricuspid regurgitation is swelling of the right ventricle. Such swelling may be a complication of any disorder that causes failure of the right ventricle.

Tricuspid regurgitation may also be caused by or made worse by valve disease on the left side of the heart such as mitral regugitation and mitral stenosis.

Other diseases can directly affect the tricuspid valve. The most common of these is rheumatic fever, which is a complication of untreated strep throat infections.

Tricuspid regurgitation may be found in those with a type of congenital heart disease called Ebstein's anomaly.

Other infrequent causes of tricuspid regurgitation include:

• Carcinoid tumors, which release a hormone that damages the valve
• Marfan syndrome
• Injury
• Rheumatoid arthritis
• Radiation therapy

Another important risk factor for tricuspid regurgitation is use of the diet medications called "Fen-Phen" (phentermine and fenfluramine) or dexfenfluramine.

Symptoms

Tricuspid regurgitation may not cause any symptoms if the patient does not have pulmonary hypertension. If pulmonary hypertension and moderate to severe tricuspid regurgitation exist together, the following symptoms may result:

• Active pulsing in the neck veins
• Decreased urine output
• Fatigue, tiredness
• General swelling
• Swelling of the abdomen
• Swelling of the feet and ankles
• Weakness

Signs and tests

The health care provider may detect abnormalities when when gently pressing with the hand (palpating) on your chest. The doctor may also feel a pulse over your liver. The physical exam may reveal liver and spleen swelling.

Listening to the heart with a stethoscope shows a murmur or abnormal sounds.There may be signs of fluid collection in the abdomen.

An ECG or echocardiogram may show swelling of the right side of the heart. Doppler echocardiography or right-sided cardiac catheterization are used to measure blood pressures inside the heart and lungs.

Treatment

Treatment may not be needed if there are few or no symptoms. Hospitalization may be required for diagnosis and treatment of severe symptoms.

Swelling may be managed by medications (diuretics) that help remove fluids from the body.

Underlying disorders should be identified and treated. Some people may be able to have surgery to repair or replace the tricuspid valve. When surgical treatment is done it is usually done as part of another procedure, most commonly mitral valve repair for mitral regurgitation.

Support Groups

Expectations (prognosis)

Treatment of any underlying conditions, especially high blood pressure in the lungs and swelling of the right lower heart chamber, may correct the disorder. Surgical valve repair or replacement usually provides a cure. However, persons with severe tricuspid regurgitation that cannot be corrected may have a poor prognosis.

Complications

• Worsening of heart failure
• Endocarditis
• Cirrhosis
• Weight loss
• Loss of appetite

Calling your health care provider

Call your health care provider if symptoms of tricuspid regurgitation are present.

Prevention

Prompt treatment of disorders that can cause valve disease reduces your risk of tricuspid regurgitation. Treat strep infections promptly to prevent rheumatic fever.

Any invasive procedure, including dental work and cleaning, can introduce bacteria into your bloodstream. The bacteria can infect a damaged mitral valve, causing endocarditis. Always tell your health care provider and dentist if you have a history of heart valve disease or congenital heart disease before treatment. Taking antibiotics before dental or other invasive procedures may decrease your risk of endocarditis.

References

Karchmer AW. Infectious endocarditis. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. St. Louis, Mo: WB Saunders; 2007:chap. 63.

Nishimura RA, Carabello BA, Faxon DP, et al. ACC/AHA 2008 Guideline update on valvular heart disease: focused update on infective endocarditis: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2008;52(8):676-685.

Review Date: May 04, 2010
Reviewed By: Issam Mikati, MD, Associate Professor of Medicine. Feinberg School of Medicine, Northwestern University, Chicago, IL. Review provided by VeriMed Healthcare Network.Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.