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Tricuspid Insufficiency

The Tricuspid Valve

The tricuspid valve is positioned on the right side of the heart between the right ventricle and the right atrium. Most tricuspid disease develops secondarily to left-sided heart disease or failure.

Primary tricuspid disease – without prior left sided heart disease is less common. Therefore, most surgical treatment of the tricuspid valve occurs concomitantly with mitral valve, aortic valve, or coronary artery bypass operation.

Tricuspid insufficiency is a valvular heart disease (sometimes referred to as “tricuspid regurgitation”). It is the failure of the heart’s tricuspid valve to close properly during heartbeats. When tricuspid insufficiency occurs, each heartbeat passes some blood from the right ventricle to the right atrium, this is the opposite of the normal direction of blood flow. Tricuspid insufficiency is rare and occurs in approximately less than 1% of people. Most people with the condition do not experience any symptoms. 

Signs and Symptoms

Although most patients with tricuspid insufficiency are asymptomatic, some may experience symptoms similar to those of right-sided heart failure, which include:

  • Accumulation of fluid in the abdomen, or swelling of the legs
  • Enlargement of the liver
  • Jugular venous distension
  • Vague upper abdominal discomfort from a congested liver
  • Fatigue due to diminished cardiac output

Causes

Most cases of tricuspid insufficiency are caused by dilation of the right ventricle. There are number of diseases which can have a direct effect on the tricuspid valve. Most common is rheumatic fever. Another condition that harms the tricuspid valve is endocarditis. Endocarditis is often infectious in nature and commonly associated with IV drug abuse.

Less frequent causes of tricuspid insufficiency include:

  • Carcinoid tumors
  • Connective tissue diseases such as Marfan syndrome
  • Systemic lupus erythematosus
  • Myxomatous degeneration
  • Injury
  • Rheumatoid arthritis
  • Radiation therapy
  • Use of diet medications including phentermine and fenfluramine or dexfenfluramine
  • Congenital defects

Treatment

Primary treatment of tricuspid insufficiency involves treating the underlying cause or causes. With many cases, surgery is not needed because the underlying problem is a dilated or damaged right ventricle. The standard medical therapy involves the use of diuretics, although this can lead to decreased cardiac output. Other medications are also available.

When surgery is indicated, the options include tricuspid valvular repair, valvuloplasty (the widening of the valve using a balloon catheter) or valve replacement. The traditional approach to repair/replace is via traditional sternotomy, however we offer a mini approach with use of robot. The robotic approach involves 3-5 3” incisions on the right side of the chest. It results in less prominent scarring and frequently allows the patient to return to their normal activities faster. Providing a two week recovery time versus two months.