Table of ContentsView AllTable of ContentsOverviewThe Tricuspid Valve and Tricuspid RegurgitationRiskCausesSymptomsDiagnosisManagementTreatment
Table of ContentsView All
View All
Table of Contents
Overview
The Tricuspid Valve and Tricuspid Regurgitation
Risk
Causes
Symptoms
Diagnosis
Management
Treatment
It quite common for a person having anechocardiogram(a very common heart test often performed in people who are basically healthy), to be told they have tricuspid regurgitation—a “leaky” tricuspid heart valve.
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Many people with tricuspid regurgitation are very surprised to learn that they have a heart valve issue because they feel fine. Their healthcare providers are often as surprised as they are, and may not know what to make of it. Fortunately, it is usually pretty straightforward for your healthcare provider to quickly evaluate this issue, decide whether or not it’s a real problem, and if so, how to manage it.
What Is Pulmonary Regurgitation?
The tricuspid valve separates the right atrium from the right ventricle. Like all heart valves, the purpose of the tricuspid valve is to make sure blood flows through the heart at the right time and in the right direction.
After the right ventricle finishes contraction and begins relaxing, pressures rapidly drop in the right ventricle. Meanwhile, pressures have risen in the right atrium.
When the right atrial pressure exceeds the right ventricular pressure, the tricuspid valve is forced open and blood begins to enter the right ventricle.
The time period when the ventricles relax and fill with blood is calleddiastole. At the end of diastole, the right atrium contracts pumping more blood into the right ventricle.
When the right ventricle contracts to eject its blood into the pulmonary artery, the tricuspid valve closes to keep blood from leaking back into the right atrium.
With tricuspid regurgitation, the tricuspid valve fails to close completely. This allows at least some blood to flow backwards—that is, to regurgitate—into the right atrium as the right ventricle contracts. Some healthcare providers term this tricuspid insufficiency and some term it tricuspid regurgitation (TR).
For a healthcare provider merely to mention to someone that they have tricuspid regurgitation is not very helpful, because the significance of this valve disorder can vary between none and severe. When tricuspid regurgitation is identified, it is important to determine the severity.
At least some tricuspid regurgitation can be detected in up to 70 percent of normal adults who have echocardiograms.Most normal tricuspid valves have a small or trivial amount of backflow into the right atrium when they close.
With today’s technology, the echocardiogram is often sensitive enough to detect that “normal” whiff of blood—and these individuals, whose valves are essentially normal, are often told they have tricuspid regurgitation, and therefore, a heart valve problem. (As an aside, the same thing happens to some extent with the mitral valve, leading many people to be inappropriately “diagnosed” withmitral valve prolapse or MVP.)
If the healthcare provider tells you that this tricuspid regurgitation is moderate or severe, then you are much more likely to have a significant heart problem that needs to be addressed. In this case, a thorough cardiac evaluation ought to be done to determine the cause and extent of the tricuspid regurgitation.
Tricuspid regurgitation that is medically significant can have two general kinds of underlying causes. First, the valve itself can become damaged because of some disease process. Second, the valve itself may be normal, but it can become leaky because an underlying cardiac problem has caused the heart to become dilated, so that the tricuspid valve can no longer close normally.
Medical conditions that can damage the tricuspid valve itself include:
Heart problems that commonly cause functional tricuspid regurgitation include:
Aortic Regurgitation (Leaky Heart Valve): What to Know
Tricuspid regurgitation is diagnosed with an echocardiogram. The two key questions after tricuspid regurgitation is diagnosed ought to be:
Both of these questions are important in deciding how—and even whether—to treat the valve problem.
In most cases, these two questions are answered quite readily when the healthcare provider performs a careful medical history and physical examination, and obtains a high-quality echocardiogram. At that point, a management plan can be developed.
Takeaway:
While most people with tricuspid regurgitation have a very mild condition that requires no treatment, sometimes it can be a serious matter. So if you are told you have tricuspid regurgitation, the first order of business is for your healthcare provider to determine the underlying cause and the severity of the condition.
The most important step in managing tricuspid regurgitation is to identify and treat the underlying cause. This is especially important with functional tricuspid regurgitation, where the tricuspid valve itself is fundamentally normal.
People who have only very mild tricuspid regurgitation without any other cardiac problems usually have tricuspid valves that are fundamentally normal, and, except for periodic follow-up examinations, need no “management” at all.
Even if intrinsic tricuspid regurgitation is moderate or severe, as long as there are no symptoms and the echocardiogram shows normal cardiac function and normal heart pressures, there should be no limitation placed on their physical activity. The only real “management” is periodic re-evaluations with a cardiologist.
There are a few situations in which valve surgery ought to be considered in people who have tricuspid regurgitation.
Surgery should become an option if the tricuspid regurgitation itself is judged to be causing significant symptoms.
Summary
If you are told you have tricuspid regurgitation, the key is for your healthcare provider to determine the underlying cause and the severity of the problem. Fortunately, this is usually not a difficult or time-consuming process.
5 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Zoghbi WA, Adams D, Bonow RO, et al.Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation: A Report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr 2017; 30:303. DOI:10.1016/j.echo.2017.01.007Al-Bawardy R, Krishnaswamy A, Bhargava M, et al.Tricuspid regurgitation in patients with pacemakers and implantable cardiac defibrillators: a comprehensive review. Clin Cardiol 2013; 36:249. DOI:10.1002/clc.22104Hahn RT.State-of-the-Art Review of Echocardiographic Imaging in the Evaluation and Treatment of Functional Tricuspid Regurgitation. Circ Cardiovasc Imaging 2016; 9. DOI:10.1161/CIRCIMAGING.116.005332Arsalan M, Walther T, Smith RL 2nd, Grayburn PA.Tricuspid regurgitation diagnosis and treatment.Eur Heart J 2017; 38:634. DOI:10.1093/eurheartj/ehv487Romeo JD, Bashline MJ, Fowler JA, et al.Current status of transcatheter tricuspid valve therapies.Heart Int. 2022;16(1):49-58. doi:10.17925/HI.2022.16.1.49Additional ReadingNishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC Guideline for the Management of Patients with Valvular Heart Disease: a Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 63:e57.
5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Zoghbi WA, Adams D, Bonow RO, et al.Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation: A Report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr 2017; 30:303. DOI:10.1016/j.echo.2017.01.007Al-Bawardy R, Krishnaswamy A, Bhargava M, et al.Tricuspid regurgitation in patients with pacemakers and implantable cardiac defibrillators: a comprehensive review. Clin Cardiol 2013; 36:249. DOI:10.1002/clc.22104Hahn RT.State-of-the-Art Review of Echocardiographic Imaging in the Evaluation and Treatment of Functional Tricuspid Regurgitation. Circ Cardiovasc Imaging 2016; 9. DOI:10.1161/CIRCIMAGING.116.005332Arsalan M, Walther T, Smith RL 2nd, Grayburn PA.Tricuspid regurgitation diagnosis and treatment.Eur Heart J 2017; 38:634. DOI:10.1093/eurheartj/ehv487Romeo JD, Bashline MJ, Fowler JA, et al.Current status of transcatheter tricuspid valve therapies.Heart Int. 2022;16(1):49-58. doi:10.17925/HI.2022.16.1.49Additional ReadingNishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC Guideline for the Management of Patients with Valvular Heart Disease: a Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 63:e57.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Zoghbi WA, Adams D, Bonow RO, et al.Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation: A Report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr 2017; 30:303. DOI:10.1016/j.echo.2017.01.007Al-Bawardy R, Krishnaswamy A, Bhargava M, et al.Tricuspid regurgitation in patients with pacemakers and implantable cardiac defibrillators: a comprehensive review. Clin Cardiol 2013; 36:249. DOI:10.1002/clc.22104Hahn RT.State-of-the-Art Review of Echocardiographic Imaging in the Evaluation and Treatment of Functional Tricuspid Regurgitation. Circ Cardiovasc Imaging 2016; 9. DOI:10.1161/CIRCIMAGING.116.005332Arsalan M, Walther T, Smith RL 2nd, Grayburn PA.Tricuspid regurgitation diagnosis and treatment.Eur Heart J 2017; 38:634. DOI:10.1093/eurheartj/ehv487Romeo JD, Bashline MJ, Fowler JA, et al.Current status of transcatheter tricuspid valve therapies.Heart Int. 2022;16(1):49-58. doi:10.17925/HI.2022.16.1.49
Zoghbi WA, Adams D, Bonow RO, et al.Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation: A Report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr 2017; 30:303. DOI:10.1016/j.echo.2017.01.007
Al-Bawardy R, Krishnaswamy A, Bhargava M, et al.Tricuspid regurgitation in patients with pacemakers and implantable cardiac defibrillators: a comprehensive review. Clin Cardiol 2013; 36:249. DOI:10.1002/clc.22104
Hahn RT.State-of-the-Art Review of Echocardiographic Imaging in the Evaluation and Treatment of Functional Tricuspid Regurgitation. Circ Cardiovasc Imaging 2016; 9. DOI:10.1161/CIRCIMAGING.116.005332
Arsalan M, Walther T, Smith RL 2nd, Grayburn PA.Tricuspid regurgitation diagnosis and treatment.Eur Heart J 2017; 38:634. DOI:10.1093/eurheartj/ehv487
Romeo JD, Bashline MJ, Fowler JA, et al.Current status of transcatheter tricuspid valve therapies.Heart Int. 2022;16(1):49-58. doi:10.17925/HI.2022.16.1.49
Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC Guideline for the Management of Patients with Valvular Heart Disease: a Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 63:e57.
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