Tricuspid Valve Disease – Repair and Valve Implantation

The tricuspid valve sits between the right atrium and the right ventricle and ensures one‑way blood flow. In tricuspid valve disease, the most common problem is tricuspid regurgitation (leakage); tricuspid stenosis (narrowing) is less frequent.

This page summarizes the medical background, diagnostic work‑up, and treatment options—including repair and valve implantation/replacement—with an emphasis on modern transcatheter (catheter‑based) therapies for selected patients.

What Is Tricuspid Valve Disease?

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Tricuspid valve disease refers to structural or functional abnormalities that:

• Prevent proper leaflet coaptation and cause backward leakage (regurgitation)
• Restrict the valve opening and limit forward flow (stenosis)

Main forms

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• Tricuspid regurgitation (TR): most common
• Tricuspid stenosis (TS): rare
• Combined disease: regurgitation and stenosis together

Tricuspid Regurgitation

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Causes

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TR is often classified as primary (organic) or secondary (functional).

Primary (organic) causes:

• Infective endocarditis
• Rheumatic disease
• Congenital anomalies (e.g., Ebstein anomaly)
• Carcinoid syndrome
• Trauma
• Degenerative leaflet changes

Secondary (functional) causes (more common):

• Left‑sided heart disease with elevated pulmonary pressures
• Pulmonary hypertension
• Right ventricular dilation/remodeling
• Long‑standing atrial fibrillation (atrial TR)
• Device leads (pacemaker/ICD) contributing to leaflet dysfunction in selected cases

Symptoms

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• Leg swelling
• Abdominal distension (ascites)
• Fatigue and reduced exercise capacity
• Shortness of breath on exertion
• Prominent neck veins

Tricuspid Stenosis

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Tricuspid stenosis is uncommon. Typical causes include rheumatic disease, carcinoid syndrome, and congenital conditions. Symptoms overlap with right‑sided congestion and heart failure.

Diagnosis: How Is the Tricuspid Valve Evaluated?

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The goals are to define severity, assess right‑sided chamber impact, and identify the underlying mechanism.

Clinical evaluation

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• Physical examination (murmur, signs of right‑sided congestion)
• ECG (rhythm assessment, especially atrial fibrillation)
• Blood tests (kidney/liver function, anemia, biomarkers as appropriate)

Imaging and hemodynamics

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• Transthoracic echocardiography (TTE): first‑line tool
• Transesophageal echocardiography (TEE, often 3D): detailed anatomy and procedural planning
• Cardiac MRI: right ventricular size/function assessment in selected cases
• Cardiac CT: annular sizing and anatomical planning when needed
• Right heart catheterization: pulmonary pressures/hemodynamics in selected patients

Treatment Options

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Treatment is individualized based on symptoms, TR/TS severity, right ventricular function, pulmonary pressures, valve anatomy, and comorbidities.

1) Medical therapy

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• Diuretics for congestion
• Optimization of heart failure therapy
• Management of underlying drivers (rhythm control for AF when appropriate, treatment of left‑sided disease, pulmonary hypertension work‑up, etc.)

Medical therapy can improve symptoms but may not be sufficient in advanced structural disease.

2) Surgery: repair or valve replacement

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• Tricuspid valve repair (often preferred): annuloplasty ring and leaflet techniques when feasible
• Tricuspid valve replacement (valve implantation): considered when repair is not feasible or has failed; bioprosthetic options are frequently discussed

3) Transcatheter (catheter‑based) therapies

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For selected patients at high surgical risk, minimally invasive transcatheter approaches may be considered:

• Edge‑to‑edge repair (TEER): approximation of leaflets to reduce regurgitation (e.g., TriClip / PASCAL)
• Annuloplasty systems: device‑based annular reduction for suitable anatomy
• Transcatheter tricuspid valve replacement (TTVR): an option in selected anatomies and clinical settings
• Caval valve implantation (CAVI): a palliative approach aimed at reducing venous congestion by placing valve(s) in the venae cavae

Suitability is determined by detailed imaging (often 3D‑TEE and CT) and multidisciplinary heart‑team evaluation.

Pre‑Procedure Work‑Up

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Common elements include:

• Comprehensive echo (TTE + often TEE)
• Assessment of other valve lesions and coronary disease (when indicated)
• Kidney function and bleeding/thrombotic risk evaluation
• Review of anticoagulants/antiplatelets with individualized planning

Risks and Recovery

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Risk depends on the selected approach (surgical vs transcatheter) and patient factors. Examples include access‑site complications, arrhythmias, bleeding/clotting issues, and incomplete reduction of regurgitation. Recovery is typically faster with transcatheter procedures compared to open surgery.

Frequently Asked Questions

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Appointment and Contact

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If you would like to schedule an appointment for tricuspid valve 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.