Overview

Tricuspid valve regurgitation is a type of heart valve disease in which the valve between the two right heart chambers (right ventricle and right atrium) doesn't close properly. As a result, blood leaks backward into the upper right chamber (right atrium).

A person may be born with tricuspid valve regurgitation (congenital heart disease). Sometimes, tricuspid valve regurgitation results from valve problems caused by other health conditions.

Mild tricuspid valve regurgitation may not cause symptoms or require treatment. If the condition is severe and causing signs and symptoms, medications or surgery may be needed.

A leaky tricuspid valve

The tricuspid valves job is to allow blood flowing into the heart from the body to flow to the right ventricle where it's pumped to the lungs for oxygen. If the tricuspid valve is leaky, blood can flow backwards, causing the heart to pump harder. Over time, the heart becomes enlarged and functions poorly.

Valve problems in children and Ebstein anomaly

Symptoms

Tricuspid valve regurgitation often doesn't cause signs or symptoms until the condition is severe. The condition may be discovered when tests are done for other reasons.

Signs and symptoms of tricuspid valve regurgitation may include:

  • Fatigue
  • Heart rhythm problems (arrhythmias)
  • Pulsing in the neck
  • Shortness of breath with activity
  • Swelling in the belly area (abdomen), legs or neck veins

When to see a doctor

Make an appointment with a health care provider if you are feeling easily fatigued or short of breath with activity. Your health care provider may refer you to a doctor trained in heart conditions (cardiologist).

Causes

To understand the causes of tricuspid valve regurgitation, it may be helpful to know how the heart and heart valves typically work.

A typical heart has four chambers. The two upper chambers (atria) receive blood. The two lower chambers (ventricles) pump blood. Four valves open and close to keep blood flowing in the correct direction. These heart valves are:

  • Aortic valve
  • Mitral valve
  • Tricuspid valve
  • Pulmonary valve

The tricuspid valve sits between the heart's two right chambers. The tricuspid valve consists of three thin flaps of tissue (called cusps, or leaflets). These valve flaps open to let blood flow from the upper right chamber (right atrium) to the lower right chamber (right ventricle). The valve flaps then close tightly to prevent the blood from moving backward.

In tricuspid valve regurgitation, the tricuspid valve doesn't close tightly. As a result, blood leaks backward into the right atrium.

Tricuspid valve regurgitation can be caused by:

  • Heart defects present at birth (congenital heart defects). Some congenital heart defects can affect the shape and function of the tricuspid valve. Tricuspid valve regurgitation in children is usually caused by a rare congenital heart defect called Ebstein anomaly. In this condition, the tricuspid valve is malformed and sits lower than usual in the right ventricle.
  • Genetic disorders. Marfan syndrome is a connective tissue disorder occasionally associated with tricuspid valve regurgitation.
  • Rheumatic fever. This complication of untreated strep throat can damage the tricuspid valve and other heart valves, causing valve regurgitation later in life.
  • Infection of the lining of the heart (infective endocarditis). An infection of the lining of the heart can damage the tricuspid valve.
  • Carcinoid syndrome. In this rare condition, tumors that develop in the digestive system and spread to the liver or lymph nodes produce a hormonelike substance that can damage heart valves, most commonly the tricuspid valve and pulmonary valves.
  • Chest injury (trauma). Experiencing trauma to the chest, such as in a car accident, may cause damage that leads to tricuspid valve regurgitation.
  • Pacemaker or cardiac device wires. Tricuspid valve regurgitation sometimes occurs during the placement or removal of pacemaker and defibrillator wires, which cross the tricuspid valve.
  • Heart muscle (endomyocardial) biopsy. In this procedure, a small amount of heart muscle tissue is removed and tested for signs of inflammation or infection. Valve damage can sometimes occur during this biopsy.
  • Radiation therapy. Receiving radiation to the chest, for example during cancer treatment, may damage the tricuspid valve and cause tricuspid valve regurgitation.

Risk factors

Several things can increase the risk of tricuspid valve regurgitation, including:

  • Congenital heart defects, such as Ebstein anomaly
  • Heart attack
  • Heart failure
  • High blood pressure (hypertension)
  • High blood pressure in the lungs (pulmonary hypertension)
  • Infections affecting the heart, such as rheumatic fever and infective endocarditis
  • Radiation to the chest area
  • Use of certain stimulants and medications used to treat Parkinson's disease and migraines
  • Weakened heart muscle (cardiomyopathy)

Complications

Potential complications of tricuspid valve regurgitation may include:

  • Atrial fibrillation (A-fib). Some people with severe tricuspid valve regurgitation also may have A-fib, a common heart rhythm disorder.
  • Heart failure. Severe tricuspid valve regurgitation can cause pressure to rise in the right lower chamber (ventricle). The right ventricle can expand and weaken over time, leading to heart failure.

Tricuspid valve regurgitation care at Mayo Clinic

Oct. 26, 2021
  1. Ferri FF. Tricuspid regurgitation. In: Ferri's Clinical Advisor 2022. Elsevier; 2022. https://www.clinicalkey.com. Accessed Aug. 17, 2021.
  2. Otto CM, et al. 2020 ACC/AHA Guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Journal of the American College of Cardiology. 2021; doi:10.1016/j.jacc.2020.11.018.
  3. Otto CM. Etiology, clinical features, and evaluation of tricuspid regurgitation. https://www.uptodate.com/contents/search. Accessed Aug. 31, 2021.
  4. Holst KA, et al. Improving results of surgery for Ebstein anomaly: Where are we after 235 cone repairs? Annals of Thoracic Surgery. 2018; doi:10.1016/j.athoracsur.2017.09.058.
  5. Heart valve disease. National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/health-topics/topics/hvd/. Accessed Aug. 31, 2021.
  6. Congenital heart defects. National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/health-topics/congenital-heart-defects. Accessed Aug. 31, 2021.
  7. Connolly HM (expert opinion). Mayo Clinic. Jan. 6, 2018.
  8. Otto CM. Management and prognosis of tricuspid regurgitation. https://www.uptodate.com/contents/search. Accessed Aug. 31, 2021.
  9. Riggin EA. Allscripts EPSi. Mayo Clinic. Jan. 6, 2021.
  10. Atrial fibrillation. National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/health-topics/atrial-fibrillation. Accessed Aug. 31, 2021.
  11. Silversides C, et al. Pregnancy and valve disease. https://www.uptodate.com/contents/search. Accessed Aug. 31, 2021.
  12. Phillips, SD (expert opinion). Mayo Clinic. Sept. 24, 2021.