Overview

Tricuspid valve regurgitation is a condition in which the valve between the two right heart chambers (right ventricle and right atrium) doesn't close properly. This situation results in blood flowing back into your heart's upper right chamber (right atrium).

Tricuspid valve regurgitation can be the result of a condition you're born with (congenital heart disease), or it can occur due to valve abnormalities caused by other conditions.

If your condition is mild, you may not need treatment, and your condition may be monitored. However, if you have severe tricuspid valve regurgitation and you're experiencing signs and symptoms, treatment may be necessary.

Find out why Mayo Clinic is the best place for your care.

Symptoms

Tricuspid valve regurgitation often doesn't cause signs or symptoms until the condition is severe. You may be diagnosed with this condition when having tests for other conditions.

Signs and symptoms of tricuspid valve regurgitation may include:

  • Fatigue
  • Declining exercise capacity
  • Swelling in your abdomen, legs or veins in your neck
  • Abnormal heart rhythms
  • Pulsing in your neck
  • An enlarged liver
  • Shortness of breath with activity

You may also experience signs or symptoms of the condition that is causing tricuspid valve regurgitation, such as pulmonary hypertension. Pulmonary hypertension symptoms may include fatigue, weakness, difficulty exercising and shortness of breath.

When to see a doctor

Severe tricuspid valve regurgitation can result in heart failure. If you have signs or symptoms of heart failure — such as feeling easily fatigued or short of breath, even with normal activity — see your doctor. Your doctor may refer you to a doctor trained in heart conditions (cardiologist).

Causes

Tricuspid valve regurgitation can have several causes.

Tricuspid valve regurgitation is usually caused by the lower right heart chamber (right ventricle) bulging (dilating), which can lead to the tricuspid valve not working properly. This can be due to several conditions that affect the right ventricle, such as heart failure, conditions that cause high blood pressure in the arteries in your lungs (pulmonary hypertension) or an abnormal heart muscle condition (cardiomyopathy). Tricuspid valve regurgitation often occurs with heart conditions that affect the left side of the heart.

Tricuspid valve regurgitation can also be caused by valve problems due to:

  • Ebstein's anomaly. In this condition, the malformed tricuspid valve sits lower than normal in the right ventricle, and the tricuspid valve's leaflets are abnormally formed. This can lead to blood leaking backward (regurgitating) into the right atrium. Tricuspid valve regurgitation in children is usually caused by heart disease present at birth (congenital heart disease), and Ebstein's anomaly is the most common congenital heart disease that causes the condition. Often it may be overlooked and not diagnosed until adulthood.
  • Infective endocarditis. The tricuspid valve may be damaged by an infection of the lining of the heart (infective endocarditis) that can involve heart valves.
  • Carcinoid syndrome. In this rare condition, tumors usually develop in your digestive system or lungs and can spread to your liver or lymph nodes. Carcinoid syndrome can cause carcinoid heart disease, a condition in which substances produced by the tumors result in scarring of the heart valves. This condition often affects the function of the tricuspid valve and pulmonary valve.
  • Implantable device wires (leads). Pacemaker or implantable cardioverter-defibrillator wires can sometimes cause injury to the tricuspid valve during placement or removal of the implantable device.
  • Endomyocardial biopsy. In an endomyocardial biopsy, a small amount of heart muscle tissue is removed and tested for signs of inflammation or infection. Valve damage can sometimes occur during this procedure.
  • Blunt chest trauma. Experiencing trauma to your chest, such as in a car accident, can lead to tricuspid valve regurgitation.
  • Rheumatic fever. Rheumatic fever — a complication of untreated strep throat and once a common childhood illness in the United States — can damage the tricuspid valve, leading to tricuspid valve regurgitation later in life. Rheumatic fever can also damage more than one heart valve, and in more than one way. Rheumatic fever is rare in the United States, but still common in some countries.
  • Congenital heart defects. Some heart defects present at birth (congenital or genetic) may affect the tricuspid valve. Most commonly this is Ebstein's anomaly.
  • Marfan syndrome. Marfan syndrome, a connective tissue disorder present at birth (congenital), can cause tricuspid valve regurgitation.
  • Medications. If you've taken certain medications such as fenfluramine (no longer sold on the market), ergot alkaloid medications such as ergotamine (Cafergot, Migergot), and some medications used for restless legs syndrome and Parkinson's disease, such as pergolide (no longer sold in the United States) or cabergoline, you may have an increased risk of tricuspid valve regurgitation.
  • Radiation. Chest radiation may damage the tricuspid valve and cause tricuspid valve regurgitation.

How the heart works

Your heart, the center of your circulatory system, is made up of four chambers. The two upper chambers (atria) receive blood. The two lower chambers (ventricles) pump blood.

Four heart valves open and close to let blood flow in one direction through your heart. The tricuspid valve — which lies between the two chambers on the right side of your heart — consists of three flaps of tissue called leaflets.

The tricuspid valve opens when blood flows from the right atrium to the right ventricle. Then the flaps close to prevent the blood that has just passed into the right ventricle from flowing backward.

In tricuspid valve regurgitation, the tricuspid valve doesn't close tightly. This causes the blood to flow back into the right atrium during each heartbeat.

Risk factors

Several factors can increase your risk of tricuspid valve regurgitation, including:

  • Infections such as infective endocarditis or rheumatic fever. These infections can cause damage to the tricuspid valve.
  • A heart attack. A heart attack can damage your heart and affect the right ventricle and function of the tricuspid valve.
  • Heart failure. Heart failure can increase your risk of developing tricuspid valve regurgitation.
  • Pulmonary hypertension. High blood pressure in the arteries in your lungs (pulmonary hypertension) can increase your risk of tricuspid valve regurgitation.
  • Heart disease. Several forms of heart disease and heart valve disease may increase your risk of developing tricuspid valve regurgitation.
  • Congenital heart disease. You may be born with a condition or heart defect that affects your tricuspid valve. Ebstein's anomaly is the most common congenital heart disease.
  • Use of certain medications. If you've used medications such as fenfluramine (no longer sold on the market), ergot alkaloid medications such as ergotamine (Cafergot, Migergot), and some medications used for restless legs syndrome and Parkinson's disease, such as pergolide (no longer sold in the United States) or cabergoline, you may have an increased risk of tricuspid valve regurgitation.
  • Radiation. Chest radiation may damage the tricuspid valve and cause tricuspid valve regurgitation.

Complications

If tricuspid valve regurgitation lasts, it can lead to:

  • Heart failure. In severe tricuspid valve regurgitation, pressure can rise in your right ventricle due to blood flowing backward into the right atrium and less blood flowing forward through the right ventricle and into the lungs. Your right ventricle can expand and weaken over time, leading to heart failure.
  • Atrial fibrillation. Some people with severe tricuspid valve regurgitation also may have a common heart rhythm disorder called atrial fibrillation.

Tricuspid valve regurgitation care at Mayo Clinic

Aug. 29, 2017
References
  1. Tricuspid regurgitation. The Merck Manual Professional Edition. http://www.merckmanuals.com/professional/cardiovascular_disorders/valvular_disorders/mitral_regurgitation.html?qt=mitral%20regurgitation&alt=sh. Accessed Nov. 7, 2014.
  2. Ebstein's anomaly. American Heart Association. http://www.heart.org/HEARTORG/Conditions/CongenitalHeartDefects/AboutCongenitalHeartDefects/Ebsteins-Anomaly_UCM_307025_Article.jsp. Accessed Nov. 7, 2014.
  3. How the heart works. National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/health-topics/topics/chd/heartworks. Accessed Dec. 3, 2014.
  4. What is heart valve disease? National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/health-topics/topics/hvd/. Accessed Nov. 7, 2014.
  5. Carcinoid heart disease. http://www.uptodate.com/home. Accessed Dec. 3, 2014.
  6. Otto CM. Etiology, clinical features, and evaluation of tricuspid regurgitation. http://www.uptodate.com/home. Accessed Nov. 7, 2014.
  7. Ferri FF. Ferri's Clinical Advisor 2015: 5 Books in 1. Philadelphia, Pa.: Mosby Elsevier; 2015. https://www.clinicalkey.com. Accessed Dec. 4, 2014.
  8. Fuster V, ed. et al. Hurst's The Heart. 13th ed. New York, N.Y.: The McGraw-Hill Companies; 2011. http://accessmedicine.mhmedical.com/book.aspx?bookId=376. Accessed Dec. 4, 2014.
  9. Agarwala BN, et al. Ebstein's anomaly and the tricuspid valve. http://www.uptodate.com/home. Accessed Nov. 7, 2014.
  10. Otto CM. Management and prognosis of tricuspid regurgitation. http://www.uptodate.com/home. Accessed Nov. 7, 2014.
  11. Nishimura RA, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: Executive summary. Journal of the American College of Caridology. 2014;63:2438.
  12. Dearani JA, et al. Strategies for tricuspid re-repair in Ebstein malformation using the cone technique. The Annals of Thoracic Surgery. 2013;96:202.
  13. Anderson HN, et al. Cone reconstruction in children with Ebstein anomaly: The Mayo Clinic experience. Congenital Heart Disease. 2014;9:266.
  14. How are arrhythmias treated? National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/health-topics/topics/arr/treatment. Accessed Dec. 8, 2014.
  15. Cullen MW, et al. Transvenous, antegrade Melody valve-in-valve implantation for bioprosthetic mitral and tricuspid valve dysfunction: A case series in children and adults. JACC: Cardiovascular Interventions. 2013;6:598.
  16. Gaasch WH, et al. Valvular heart disease induced by drugs. http://www.uptodate.com/home. Accessed Dec. 9, 2014.
  17. Brown ML, et al. The outcomes of operations for 539 patients with Ebstein anomaly. The Journal of Thoracic and Cardiovascular Surgery. 2008;134(5):1121.
  18. Said SM, et al. Management of tricuspid regurgitation in congenital heart disease: Is survival better with valve repair? The Journal of Thoracic and Cardiovascular Surgery. 2014;147:412.
  19. U.S. News Best Hospitals 2014-15. U.S. News & World Report. http://health.usnews.com/best-hospitals/rankings. Accessed Dec. 29, 2014.
  20. Dearani JA (expert opinion). Mayo Clinic, Rochester, Minn. Jan. 2, 2015.
  21. Warnes CA (expert opinion). Mayo Clinic, Rochester, Minn. Jan. 5, 2015.
  22. Connolly HM. Pregnancy in women with congenital heart disease. Current Cardiology Reports. 2005;7:305.
  23. Miller HL. Decision Support System. Mayo Clinic, Rochester, Minn. Accessed Dec. 29, 2014.
  24. Cook AJ. Decision Support System. Mayo Clinic, Rochester, Minn. April 3, 2014.
  25. Miller HL. Decision Support System. Mayo Clinic, Rochester, Minn. Accessed Dec. 29, 2014.
  26. Algarni KD, et al. Robotic-assisted mitral valve repair: Surgical technique. Multimedia Manual of Cardio-Thoracic Surgery. 2014;2014:e1. http://mmcts.oxfordjournals.org/content/2014/mmu022.full?sid=f176f3ea-c51d-42cc-871f-9c7d8b10c943. Accessed Jan. 9, 2015.
  27. Severson RM. Society of Thoracic Surgeons National Database. Accessed Jan. 15, 2015.

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