Diagnosis
Tricuspid valve regurgitation can happen silently. Healthcare professionals may find it when doing imaging tests of the heart for other reasons.
To diagnose tricuspid valve regurgitation, a healthcare professional examines you and asks questions about your symptoms and medical history. The healthcare professional listens to your heart using a device called a stethoscope. A whooshing sound called a heart murmur may be heard.
Tests
To learn if you have tricuspid valve regurgitation, your healthcare team does tests to check your heart and heart valves. The tests can show how severe any valve disease is and help your care team learn the cause.
Echocardiogram
An echocardiogram uses sound waves to create pictures of the heart in motion. The test can show the structure of the heart and heart valves and how blood flows through the heart.
Tests to diagnose tricuspid valve regurgitation may include:
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Echocardiogram. This is the main test for diagnosing tricuspid valve regurgitation. Sound waves make pictures of the beating heart. The test shows how blood flows through the heart and the heart valves, including the tricuspid valve.
There are different types of echocardiograms. A standard echocardiogram is called a transthoracic echocardiogram (TTE). It makes pictures of the heart from outside the body. Sometimes, a healthcare professional may need a more detailed echocardiogram to better see the tricuspid valve. This test is called a transesophageal echocardiogram (TEE). It makes pictures of the heart from inside the body. The type of echocardiogram you have depends on the reason for the test and your overall health.
- Electrocardiogram (ECG or EKG). This quick test records the electrical signals in the heart. It shows how the heart is beating. Sticky patches with sensors on them, called electrodes, go on the chest and sometimes the legs. Wires connect the sensors to a computer, which shows or prints results.
- Chest X-ray. A chest X-ray shows the condition of the heart and lungs.
- Cardiac MRI. This test uses magnetic fields and radio waves to make detailed pictures of the heart. Cardiac MRI may help show the severity of tricuspid valve regurgitation. The test also gives details about the lower right heart chamber.
- Cardiac catheterization. This test isn't often used to diagnose tricuspid valve disease. But it can be helpful if other tests haven't diagnosed the cause of the condition. A doctor guides a thin, soft tube called a catheter through a blood vessel in the arm or groin and moves it to an artery in the heart. A substance called contrast flows through the tube. This makes the heart arteries show up more clearly on X-rays taken during the test. The doctor also may measure pressures in the heart during this test.
Staging
After testing confirms a diagnosis of tricuspid or other heart valve disease, your healthcare team may tell you the stage of disease. Staging helps determine the most appropriate treatment.
The stage of heart valve disease depends on many things, including symptoms, disease severity, the structure of the valve or valves, and blood flow through the heart and lungs.
Heart valve disease is staged into four basic groups:
- Stage A: At risk. Risk factors for heart valve disease are present.
- Stage B: Progressive. Valve disease is mild or moderate. There are no heart valve symptoms.
- Stage C: Asymptomatic severe. There are no heart valve symptoms, but the valve disease is severe.
- Stage D: Symptomatic severe. Heart valve disease is severe and is causing symptoms.
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Treatment
Treatment for tricuspid valve regurgitation depends on the cause and how severe it is. The goals of treatment are to:
- Help the heart work better.
- Reduce symptoms.
- Improve quality of life.
- Prevent complications.
Tricuspid regurgitation treatment may include:
- Medicines.
- A heart procedure.
- Surgery to repair or replace the heart valve.
The exact treatment depends on your symptoms and how severe the valve disease is. Some people with mild tricuspid valve regurgitation only need regular health checkups. Your healthcare team tells you how often you need appointments.
Medications
Your healthcare professional may suggest medicines to control symptoms of tricuspid valve regurgitation. Medicines also may be used to treat the cause of the condition.
Some medicines used for tricuspid valve regurgitation are:
- Diuretics. Often called water pills, these medicines make you urinate more often. This helps prevent fluid buildup in the body.
- Potassium-sparing diuretics. Also called aldosterone antagonists, these medicines may help some people with heart failure live longer.
- Other medicines to treat or control heart failure.
- Medicines to control irregular heartbeats. Some people with tricuspid valve regurgitation have a type of irregular heartbeat called atrial fibrillation (AFib).
Therapies
Those who have pulmonary hypertension with tricuspid valve regurgitation may need supplemental oxygen.
Surgery or other procedures
You may need surgery to repair or replace a diseased or damaged tricuspid valve.
Doctors may do tricuspid valve repair or replacement as open-heart surgery or a surgery with smaller cuts, called minimally invasive surgery. Sometimes, doctors may treat tricuspid valve regurgitation using thin, flexible tubes called a catheters and a balloon or clip.
You may need tricuspid valve repair or replacement surgery if:
- The valve disease is severe and causes symptoms, such as shortness of breath.
- Your heart is getting bigger or weaker, even if you don't have symptoms of tricuspid valve regurgitation.
- You have tricuspid valve regurgitation and need heart surgery for another condition, such as mitral valve disease.
Types of heart valve surgery to treat tricuspid valve regurgitation include:
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Tricuspid valve repair. Surgeons recommend valve repair when possible. It saves the heart valve. It also may reduce the need for long-term use of blood thinners.
Tricuspid valve repair is typically done as an open-heart surgery. A long cut is made in the center of the chest. A surgeon may patch holes or tears in the valve, or separate or reconnect valve flaps. Sometimes the surgeon removes or reshapes tissue to help the tricuspid valve close more tightly. The surgeon also may replace cords of tissue that support the valve.
If Ebstein anomaly is the cause of tricuspid regurgitation, heart surgeons may do a type of valve repair called the cone procedure. During this treatment, the surgeon separates the tricuspid valve flaps from the heart muscle. Then the surgeon rotates the flaps and attaches them again.
If you have severe tricuspid regurgitation and standard repair surgery isn't an option, your healthcare professional may suggest tricuspid transcatheter edge-to-edge repair (T-TEER). This newer treatment uses tubes called catheters and a clip to fix a leaky tricuspid valve. The clip brings the valve flaps closer together so less blood goes backward. Open-heart surgery is not needed for T-TEER. People with tricuspid regurgitation who have this treatment often have fewer symptoms and a better quality of life.
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Tricuspid valve replacement. If the tricuspid valve can't be repaired, surgery may be needed to replace the valve. Surgeons may do tricuspid valve replacement surgery as open-heart surgery or minimally invasive surgery.
During tricuspid valve replacement, a surgeon removes the damaged or diseased valve. The surgeon replaces the valve with a mechanical valve or a valve made from cow, pig or human heart tissue. A tissue valve is called a biological valve.
If you have a mechanical valve, you need to take blood thinners for the rest of your life to prevent blood clots. Biological tissue valves don't need lifelong blood thinners. But they can wear down over time and may need to be replaced. Together, you and your care team discuss the risks and benefits of each type of valve to decide which one is best for you.
- Valve-in-valve replacement. If you have a biological tissue tricuspid valve that's no longer working, a catheter treatment may be done instead of open-heart surgery to replace the valve. The doctor inserts a soft tube called a catheter into a blood vessel and guides it to the tricuspid valve. The replacement valve goes through the catheter and into the existing biological valve.
After tricuspid repair or replacement, you need regular health checkups to make sure your heart is working as it should.
Pregnancy
People who have tricuspid valve disease need careful and regular checkups during pregnancy. If you have severe tricuspid valve regurgitation, your care team may tell you not to get pregnant to lower the risk of complications, including heart failure.
Cone procedure for tricuspid valve repair
In the cone procedure, a surgeon separates the tricuspid valve flaps, called leaflets, and reshapes them so that they work properly.
During the cone procedure, the surgeon isolates the deformed leaflets of the tricuspid valve. The surgeon then reshapes them so they function properly.
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Lifestyle and home remedies
If you have tricuspid valve regurgitation or any type of heart disease, your healthcare team may suggest making lifestyle changes. Try these tips:
- Eat healthy foods. Eat plenty of fruits and vegetables, whole grains and lean proteins. Do not eat saturated fats and trans fats, sugar and refined grains. Do not add salt to food. If you have heart failure, your care team may tell you to reduce fluids and salt.
- Don't smoke or use tobacco. Smoking is a major risk factor for coronary artery disease. Nicotine tightens blood vessels and forces the heart to work harder. Not smoking is one of the best ways to lower the risk of a heart attack. If you need help quitting, talk with your healthcare team.
- Get regular exercise and stay active. Exercise can help improve heart health. Try to get 30 to 60 minutes of physical activity most days of the week. Ask your healthcare team what amount and type of exercise is right for you.
- Keep a healthy weight. Being overweight is a risk factor for heart disease. Ask your healthcare team what a healthy weight is for you.
- Practice good sleep habits. Poor sleep may raise the risk of heart disease. Adults should try to get 7 to 9 hours of sleep daily. Go to bed and wake at the same time every day, including on weekends. If you have trouble sleeping, talk with your healthcare team.
- Manage blood pressure, cholesterol and blood sugar. High blood pressure and high cholesterol raise the risk of heart disease. Make lifestyle changes and take medicines as directed to manage high blood pressure, high blood sugar and high cholesterol. If you have diabetes, managing your blood sugar can help lower your risk of heart disease.
- Manage stress. Find ways to help lower any emotional stress. Some tips are to get more exercise, practice mindfulness and connect with others in support groups.
If you had your tricuspid valve replaced, ask your care team if you need to take antibiotics before some types of dental work, such as gum surgery. Some people with replacement heart valves need antibiotics. The medicine helps stop germs from getting into the bloodstream and reaching the lining of the heart. An infection of the lining of the heart is called infective endocarditis.
Preparing for your appointment
If a healthcare professional thinks you might have tricuspid valve regurgitation, you are usually sent to a doctor trained in heart diseases. This type of doctor is called a cardiologist. If you were born with a heart condition, you may see a type of heart doctor called a congenital cardiologist.
Here's some information to help you get ready for your appointment.
What you can do
- Ask if there is anything you need to do before your appointment. For example, your healthcare professional may tell you not to eat or drink for a short time before a cholesterol test.
- Write down your symptoms, including any that may not seem related to tricuspid valve regurgitation.
- Write down important personal information. This includes a family history of heart valve disease and any major stresses or recent life changes.
- Make a list of all the medicines, vitamins and supplements you take. Include those you bought without a prescription. Also include the doses.
- Take someone with you, if possible. Someone who goes with you can help you remember information you're given.
- Write down questions to ask the healthcare team.
Time with your healthcare professional may be short. Writing down questions before your visit can help you use your time well. For tricuspid valve regurgitation, some basic questions to ask your care team include:
- What's the most likely cause of my symptoms?
- What tests do I need? Do I need to do anything to get ready for them?
- I feel OK. Do I still need treatment?
- What tests do I need?
- What's the best treatment?
- Are there other treatment options?
- I have other health conditions. How can I best manage them together?
- Do I need to change my activities, sports or diet?
- Should I see a specialist?
- If I need heart valve surgery, which surgeon do you recommend?
- Is there any information that I can take home with me?
- What websites do you recommend?
Don't hesitate to ask other questions.
What to expect from your doctor
Your healthcare team is likely to ask you a number of questions. Being ready to answer them may save time to go over any questions or concerns you want to spend more time on. Your care team may ask:
- When did you first notice symptoms?
- Do you always have symptoms or do they come and go?
- How severe are your symptoms?
- What, if anything, makes your symptoms better?
- What, if anything, makes your symptoms worse?