What is Tricuspid Valve Disease?#
The tricuspid valve regulates blood flow from the right atrium to the right ventricle. In valve disease, this function is impaired and creates additional burden on the right heart.
Types of Tricuspid Valve Disease:
- Tricuspid regurgitation
- Tricuspid stenosis - rare
- Combined tricuspid valve disease
Tricuspid Regurgitation#
Causes#
Primary (Organic):
- Endocarditis
- Rheumatic disease
- Carcinoid syndrome
- Trauma
- Congenital anomalies
Secondary (Functional):
- Left heart disease
- Pulmonary hypertension
- Right ventricular dilation
- Atrial fibrillation
Symptoms#
- Leg swelling
- Abdominal swelling (ascites)
- Fatigue
- Shortness of breath
- Neck vein distension
Grading#
| Grade | Vena Contracta | Regurgitant Volume |
|---|---|---|
| Mild | <3 mm | <15 ml |
| Moderate | 3-6.9 mm | 15-29 ml |
| Severe | ≥7 mm | ≥30 ml |
| Massive | >14 mm | >45 ml |
Tricuspid Stenosis#
Causes#
- Rheumatic disease
- Carcinoid syndrome
- Congenital
Symptoms#
- Right heart failure signs
- Hepatomegaly
- Ascites
Tricuspid Valve Disease Diagnosis#
Physical Examination#
- Systolic murmur (regurgitation)
- Diastolic murmur (stenosis)
- Neck vein distension
- Hepatomegaly
Imaging#
- Transthoracic echocardiography
- Transesophageal echocardiography
- Cardiac MRI
- Right heart catheterization
Tricuspid Valve Disease Treatment#
Medical Treatment#
- Diuretics
- Sodium restriction
- Treatment of underlying disease
- Heart failure treatment
Surgical Treatment#
Tricuspid Valve Repair:
- Annuloplasty ring
- Preferred method
Tricuspid Valve Replacement:
- If repair not possible
- Bioprosthetic valve preferred
Interventional Treatment#
Transcatheter Tricuspid Interventions:
Modern treatment methods developed for patients who are high risk for surgery, performed via catheter from the groin without opening the chest.
1. TriClip (Edge-to-Edge Repair): It is the adaptation of the MitraClip technology used for the mitral valve to the tricuspid valve. It is an approved method for patients with high surgical risk.
- How it Works: The heart is accessed via the groin and the tricuspid valve leaflets are clipped together.
- Mechanism of Action: The valve opening is reduced by the “clipping” method, reducing backward leakage (regurgitation).
- Advantage: It is a non-surgical, minimally invasive method. Detailed studies show safety and improved quality of life in high-risk patients.
2. PASCAL System: It is an “edge-to-edge repair” system similar to TriClip but with a different design.
- Difference: It contains a “spacer” placed between the leaflets. This design reduces stress on the leaflets and provides a larger grasping surface.
- Usage Area: It may be preferred in anatomies with a wide gap between leaflets or where leaflets are very mobile.
3. Emerging Technologies: This field is advancing rapidly with devices having different mechanisms:
Caval Valve Implantation (CAVI): This method does not repair the tricuspid valve itself; instead, it places valve(s) in the Vena Cava (main veins).
- Goal: To relieve symptoms like swelling (edema) by preventing backflow to the liver and legs.
- For Whom: Used for “palliative” (symptomatic relief) purposes in patients with very high surgical risk who are anatomically unsuitable for valve repair/replacement.
Transcatheter Tricuspid Valve Replacement (TTVI / TTVR): Complete replacement of the dysfunctional valve with a new artificial bioprosthetic valve via catheter.
- Status: Advanced systems like Evoque and LuX-Valve are available. It allows for complete valve renewal in patients who are functionally or anatomically unsuitable for repair. Clinical trials are showing promising results.
Treatment Timing#
Treatment decision depends on:
- Presence of symptoms
- Right ventricular function
- Accompanying left heart surgery
- Pulmonary pressure
Frequently Asked Questions#
Is tricuspid regurgitation dangerous?
What are the symptoms of tricuspid valve disease?
How is tricuspid regurgitation treated?
Is tricuspid valve surgery risky?
Can tricuspid regurgitation resolve on its own?
Appointment and Contact#
If you would like to schedule an appointment for tricuspid valve disease evaluation:
📍 Avrasya Hospital - Beştelsiz Mah. 101. Sokak No:107, Zeytinburnu, Istanbul
📞 Phone: +90 212 665 50 50 (Ext: 4012)
This content has been prepared by Assoc. Prof. Dr. Habib Çil for general informational purposes. Please consult a cardiology specialist for definitive diagnosis and treatment. Other topics related to tricuspid valve disease:
- Mitral Valve Disease - Mitral valve diseases
- Heart Valve Diseases - General information
- MitraClip and Tricuspid Valve Interventions - Modern treatment methods