Tricuspid Regurgitation

TR is much more common than other tricuspid valve diseases, such as tricuspid valve stenosis.

This valvular heart disease is also called:

1. Tricuspid insufficiency
2. Leaky tricuspid valve
3. Tricuspid valve regurgitation

Read on for more information about the causes, treatment of tricuspid regurgitation,  and tricuspid valve surgery.

Types of Tricuspid Valve Regurgitation & Causes

Tricuspid regurgitation falls into two main categories based on what’s causing it. Secondary TR is far more common, accounting for about 95% of cases with moderate-to-severe regurgitation.

Primary Tricuspid Regurgitation (8-10% of cases)

This type occurs when there is actually a problem with ventricular function. Think of it like a faucet that doesn’t shut off properly due to damage to the faucet itself.

Congenital abnormalities (present from birth) include Ebstein’s disease, where the valve leaflets are positioned lower than usual in the heart chamber.

Acquired causes (developing over time) include:

• Endocarditis (infections of the heart)
• Rheumatic fever
• Wear and tear or bulging of the leaflets (degeneration or prolapse)
• Failure of an artificial valve
• Damage from medical device leads (pacemakers or defibrillators)
• Heart tumours (such as carcinoid syndrome or myxoma)
• Certain medications (some diet drugs, dopamine agonists, ergot-based medications)
• Systemic diseases (lupus, sarcoidosis)
• Radiation therapy
• Trauma

Secondary Tricuspid Regurgitation (90-95% of cases)

This is the more common type. The valve itself is structurally sound, but your heart has changed in a way that causes it to leak. Imagine that same faucet, but now the sink itself has warped so the faucet can’t seal properly anymore.

Common causes include:

• Left-sided heart problems, including heart failure (54% of secondary TR cases): When the left side of the heart is weak or has valve problems, pressure backs up and weakens the right heart. More than 25% of patients with severe aortic stenosis and 30-50% of patients with severe mitral regurgitation develop significant TR.
• Atrial fibrillation and other rhythm problems (24% of cases): Irregular heartbeats cause the upper heart chambers to enlarge, stretching the tricuspid valve and preventing it from closing correctly.
• Lung disease (17% of cases): High blood pressure in the lungs or chronic lung disease puts extra strain on the right heart, causing it to enlarge and the valve to leak.
• Right heart disease (4% of cases): Conditions that directly damage the right heart, such as inferior heart attacks or inherited right heart muscle disease, can cause the valve to leak.
• Pericardial disease (1% of cases): Problems with the lining surrounding the heart.

Isolated Tricuspid Regurgitation

Some people, usually older adults with erratic heartbeats, develop tricuspid valve leaking without having lung disease or left-sided heart problems.

In these cases, the upper right chamber of the heart and the valve ring become enlarged due to the irregular rhythm, leading to valve leakage.

What This Means for You

The type of TR you have affects how serious it is and what your doctor recommends. People with secondary TR tend to have more complex health issues because they usually have other heart or lung problems too.

Among secondary causes, lung disease tends to have the most serious outlook, while valve leaking from erratic heartbeats alone tends to have a better prognosis.

The good news is that treating the underlying cause can help improve how you feel and your long-term health.

Increased Risk Factors

• Ageing
• Pulmonary hypertension
• Right ventricular dysfunction
• Left heart valve disease
• Long-standing atrial fibrillation
• Cardiac device leads crossing the valve

Tricuspid Valve Regurgitation Symptoms

In many cases, patients are asymptomatic or might simply tolerate tricuspid valve regurgitation.

Symptoms include:

• Severe ankle and stomach swelling
• Shortness of breath
• Lethargy

Tricuspid Regurgitation Diagnosis

Tricuspid regurgitation is often discovered by chance during a routine heart ultrasound done for another reason. Your doctor will then do further tests to determine the severity.

Transthoracic echocardiography (TTE) is the standard test. It’s an ultrasound that shows:

• Whether you have tricuspid regurgitation and its severity
• Valve structure and what’s causing the leak
• How well your right heart is working
• Pressure in your lung blood vessels
• Any other heart problems

Echocardiography also allows doctors to assess the clinical features of the pulmonary valve and right ventricle, since problems in these areas often occur alongside tricuspid regurgitation.

Other tests:

• Transesophageal echocardiogram (TEE): A probe guided down your throat gives clearer pictures. It’s mainly used to plan surgery or determine if the valve can be repaired.
• Right heart catheterisation: A thin tube measures heart pressures directly. Your doctor uses this when ultrasound findings don’t match your symptoms or when lung pressure estimates are unclear.
• Cardiac magnetic resonance Imaging (CMR): Advanced imaging that shows detailed heart structure, particularly useful for complex, severe cases. It accurately measures the amount of blood leaking and can detect heart muscle damage.

Tricuspid Valve Regurgitation Treatment in London

There are several tricuspid regurgitation treatment options, depending on the stage of the disease and the patient’s health.

Tricuspid Valve Regurgitation Surgery

Depending on the severity of the tricuspid regurgitation, your doctor may suggest tricuspid valve repair or tricuspid valve replacement. The Keyhole London Heart Clinic specialises in minimally invasive valve surgery and would always recommend this option to eligible patients.

• Tricuspid valve repair is performed by the insertion of a ring, which reshapes the outer ring of the valve to allow the leaflets to seal properly.
• During replacement tricuspid valve surgery, the valve is completely replaced with either a tissue-based or mechanical valve.

In some cases of mitral valve disease, a leaking tricuspid valve will need to be repaired at the same time.

The benefits of our minimally invasive tricuspid valve regurgitation surgery in London over traditional open heart surgery include:

• Much less scarring
• Much less pain or trauma
• Less blood loss
• Shorter recovery time

Transcatheter Treatment

Transcatheter treatment is a minimally invasive procedure that doesn’t require surgery. Instead, doctors use thin tubes (catheters) to guide a device through your blood vessels to repair your tricuspid valve.

This treatment works well for people with isolated tricuspid regurgitation who:

• Have symptoms affecting their quality of life
• Are too high-risk for surgery

During your evaluation, we will determine if it’s right for you based on your age, health, and individual circumstances.

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Keyhole Heart Clinic: Minimally Invasive Treatment Options

The Keyhole Heart Clinic provides innovative treatments with compassionate patient care. Our lead surgeon, Mr Birdi, is one of the few cardiologists in the world with the training and experience to perform keyhole surgeries, such as:

• Keyhole coronary bypass surgery
• Keyhole mitral valve repair or replacement surgery
• Keyhole tricuspid valve replacement
• Keyhole aortic valve replacement
• Keyhole atrial fibrillation ablation
• Keyhole atrial septal defect closure

We also focus on overall heart health and prevention by offering comprehensive heart screening services at our London and Essex Heart Clinics

Do you have any questions about tricuspid regurgitation treatment in London? Simply get in touch, and a friendly member of our team will be able to advise and help you understand the condition.