Tricuspid regurgitation is a disorder involving backwards flow of blood across the tricuspid valve which separates the right ventricle (lower heart chamber) from the right atrium (upper heart chamber). This occurs during contraction of the right ventricle and is caused by damage to the tricuspid heart valve or enlargement of the right ventricle.
The tricuspid valve is between the right atrium and right ventricle in the heart. The valve opens when the atrium contracts to allow blood to flow into the ventricle. It closes when the ventricle contracts to prevent back flow (regurgitation) of blood into the atrium. If there is regurgitation, blood does not flow through easily, which makes the ventricle work too hard. Abnormalities in the tricuspid valve are unusual. When present, they often exist with abnormalities of other valves, such as mitral stenosis. The damage may be congenital (present at birth) or caused by enlargement of the right ventricle. It may be from infections in the heart such as rheumatic fever (from a previous streptococcal infection) or bacterial endocarditis.
There may be no symptoms of tricuspid regurgitation. However, because tricuspid regurgitation often exists with mitral stenosis, symptoms may develop. Symptoms that do occur usually begin many years after the bout with rheumatic fever and are associated with symptoms of heart failure. Swelling in the legs or abdomen (causing tenderness in the liver) or difficulty with breathing, especially when you are lying down, may occur. Other symptoms include irregular heartbeat, coughing up blood, or chest pain. Atrial fibrillation may develop, and the atrium does not contract normally. Because blood pools in the atrium if the atrium is not contracting normally, clots may form. These blood clots may travel out of the heart when normal contractions resume. Because of this possibility, some patients undergo an operation to have their valve widened or replaced.
Heart valve disease is diagnosed on the basis of symptoms and findings at a physical examination. Blood moving abnormally through the valve makes an abnormal sound called a murmur. The timing of the murmur in the cardiac cycle and the location of the murmur help determine which valve is affected. An echocardiogram (ultrasound examination of the heart) shows the abnormal valve and is used to assess blood flow through the valve. Chest radiographs (x-rays) often show the right atrium and ventricle enlarged from overfilling and leakage of fluid into the lungs. An ECG may show arrhythmias such as atrial fibrillation, which occur if the changes in the atrium affect the electrical system of the heart. This may cause palpitations or a rapid heartbeat.
Treatment may not be needed if there are few or no symptoms. Hospitalization may be required for diagnosis and treatment of severe symptoms. Underlying disorders should be identified and treated. Surgery to repair or replace the tricuspid valve (heart valve surgery) may be needed. Treatment of the underlying cause of the tricuspid regurgitation may help restore the normal function of the valve. For example, congestive heart failure can be treated with heart medications. Heart valve infections often go away with antibiotics. If there is no underlying disease, treatment may not be needed. This is common in the elderly, who often get mildly leaky valves. Open heart surgerycan be used to repair or replace the valve in severe cases.