Tricuspid Regurgitation

The tricuspid valve sits between the right atrium and the right ventricle. Blood returning to the lungs for oxygenation must traverse the tricuspid valve on its way to the pulmonary artery. The right side of the heart is a low pressure system. When disease progresses on the left side of the heart, it can cause changes on the right side by raising the pressure. The tricuspid valve is often the focal point for these changes.
Tricuspid regurgitation (TR) can be detected by cardiac ultrasound (echocardiogram) or physical examination. If the valve is abnormal, it is most common to find regurgitation, or leaking, of the valve. Some causes of tricuspid valve disease include rheumatic heart disease, infective endocarditis (especially in IV drug abuses), radiation injury, Marfan syndrome and Ebstein's anomaly. A rare cause of tricuspid valve disease and TR is use of the diet drugs, fenfluramine and dexfenfluamine.
TR is commonly caused by progressive mitral valve disease. Both mitral stenosis and mitral regurgitation can result in an increase in the pressures in the lungs. Patients will have symptoms of breathlessness. At the time of surgery for mitral valve disease, it is recommended to repair the tricuspid valve in order to improve the right heart hemodynamics. If left untreated, TR after mitral valve surgery can result in a worse long-term prognosis.
It is rare to find TR in the absence of mitral valve disease. Replacement of the tricuspid valve may be needed in lone TR, if significant pulmonary hypertension and symptoms of breathlessness are present. Simply "cinching the valve down" (annuloplasty) can repair the valve in many cases. If a mechanical valve is placed in a young patient, anticoagulation with coumadin is needed for life to prevent valve clotting. In most healthy patients undergoing an echocardiogram for screening purposes, the finding of TR is often not a significant finding and warrants no further treatment of evaluation.