Tricuspid valve disease

Symptoms of tricuspid valve disease depend on the specific valve condition and how severe it is.

Tricuspid stenosis symptoms are often mild. Symptoms may include:

• A fast, pounding heartbeat.
• Fluttering feeling in the neck.
• Fatigue.

People with tricuspid regurgitation may not have symptoms. But the condition may cause vague symptoms such as weakness, fatigue, and swelling in the legs or belly. Sometimes there is a pulsing feeling in the neck veins.

Tricuspid atresia and Ebstein anomaly symptoms often are seen at birth. They may include:

• Blue or gray skin and lips. Depending on skin color, these changes may be easier or harder to see.
• Difficulty breathing.
• Slow growth and poor weight gain.
• Tiring easily, especially during feedings.

Some types of tricuspid valve disease may cause symptoms of right-sided heart failure. Right-sided heart failure symptoms include:

• Fatigue and weakness.
• Shortness of breath.
• Swelling in the legs, ankles and feet.
• Swelling of the belly area, a condition called ascites.
• Sudden weight gain from a buildup of fluid.

When to see a doctor

If you have changes in your heartbeat or unexplained weakness or fatigue, make an appointment for a health checkup. You may be sent to a doctor trained in heart diseases, called a cardiologist.

Causes of tricuspid valve disease depend on the specific condition.

To understand the causes of heart valve disease, it may be helpful to know how the heart works.

Four valves in the heart keep blood flowing in the right direction. These valves are:

• Aortic valve.
• Mitral valve.
• Pulmonary valve.
• Tricuspid valve.

Each valve has flaps, called leaflets or cusps. The flaps open and close once during each heartbeat. If a valve flap doesn't open or close properly, less blood moves out of the heart to the rest of the body.

Some people are born with tricuspid valve disease. In others, it happens later in life. Some causes of tricuspid valve disease later in life are:

• Infection of the lining of the heart and heart valves, called infective endocarditis.
• A complication of strep throat that's not treated, called rheumatic fever.
• A connective tissue disorder called Marfan syndrome.
• Carcinoid syndrome, caused by a rare tumor that releases certain chemicals.
• Heart tumors or cancer that has spread to the right side of the heart.
• Lupus and other autoimmune diseases.
• Scarring from chest radiation or pacemaker placement.
• An irregular heartbeat called atrial fibrillation (AFib).
• High pressures in the lungs, called pulmonary hypertension.

Risk factors for tricuspid valve disease depend on the specific condition.

Anything that causes swelling or irritation of the right side of the heart or changes in the structure of the valve can increase the risk of tricuspid valve disease.

To diagnose tricuspid valve disease, a healthcare professional examines you and listens to your heart and lungs. Tests are done to check heart health. Tricuspid valve disease may be found when tests are done for another reason.

Some types of tricuspid valve disease may be hard to diagnose. You may be sent to a doctor trained in heart diseases, called a cardiologist.

Tests

Tests to diagnose tricuspid valve disease may include:

• Chest x-ray. This test shows the condition of the heart and lungs. It can tell if the heart is larger than usual.
• Electrocardiogram (ECG or EKG). This quick test shows how the heart beats. Sticky patches with sensors on them attach to the chest and sometimes the legs. Wires connect the patches to a computer, which prints or displays results.
• Echocardiogram. Sound waves create pictures of the beating heart. This test shows how blood moves through the heart and heart valves. It can show if the tricuspid valve is thickened or changed.
• Right-sided heart catheterization. This test checks the pressure and blood flow in the right side of the heart. Changes in the right side of the heart can lead to tricuspid valve disease. A doctor inserts a flexible tube called a catheter into a blood vessel in the groin or neck. The doctor guides the tube to the heart. The catheter has special sensors on it that take the measurements.
• Heart MRI, also called cardiac MRI. This test may be done if an echocardiogram doesn't give enough information about the tricuspid valve. A heart MRI uses a magnetic field and computer-generated radio waves to create detailed images of the heart.

Staging

After testing confirms a diagnosis of tricuspid valve disease, your healthcare team may tell you the stage of disease. Staging helps determine the most appropriate treatment.

The stage of heart valve disease depends on many things, including symptoms, disease severity, the structure of the valve or valves, and blood flow through the heart and lungs.

Heart valve disease is staged into four basic groups:

• Stage A: At risk. Risk factors for heart valve disease are present.
• Stage B: Progressive. Valve disease is mild or moderate. There are no heart valve symptoms.
• Stage C: Asymptomatic severe. There are no heart valve symptoms but the valve disease is severe.
• Stage D: Symptomatic severe. Heart valve disease is severe and is causing symptoms.

Treatment of tricuspid valve disease depends on the specific valve condition and how severe it is.

Treatment may include:

• Regular health checkups.
• Medicines.
• Surgery to fix or replace the valve.

If tricuspid valve disease symptoms are not bothering you, you may only need regular echocardiograms to see how the valve is working.

Medications

Medicine may be used to treat:

• The underlying cause of tricuspid valve disease.
• Complications such as heart failure.

For example, diuretics, also called water pills, may be given to help remove fluid from the body.

If a current infection causes tricuspid valve disease, antibiotics are usually given.

If a lung condition causes tricuspid valve disease, oxygen therapy may help reduce symptoms.

Surgeries or other procedures

If you have severe tricuspid valve disease, surgery may be done to fix or replace the valve.

Balloon valvotomy

This treatment may be done if you have tricuspid stenosis. A doctor places a thin tube with a balloon on the end into a blood vessel and guides it to the heart. Once in place, the balloon inflates. This makes the valve opening wider, improving blood flow. The catheter and balloon are removed.

Tricuspid valve repair and replacement

Tricuspid valve repair and tricuspid valve replacement are types of heart surgery. They can help improve blood flow and reduce symptoms.

The type of tricuspid valve surgery needed depends on:

• The symptoms.
• How severe tricuspid valve disease is, also called the stage.
• Age and overall health.
• Whether the condition is getting worse.
• Whether surgery is needed to correct another valve or heart condition.

Surgeons do tricuspid valve repair when possible. Repair saves the heart valve and improves how the heart works. Tricuspid valve repair is usually done with open-heart surgery. Sometimes, a tricuspid valve can be repaired with minimally invasive heart surgery or a procedure using thin tubes called catheters and a clip.

If the tricuspid valve can't be fixed, a surgeon removes the damaged or diseased valve. The valve is most often replaced with a valve made from cow, pig or human heart tissue. A tissue valve is called a biological valve. Rarely, a mechanical valve is used.

If you have a biological tissue tricuspid valve that's no longer working, a doctor may use a catheter-based treatment instead of open-heart surgery to replace the valve. A catheter is a thin flexible tube. The doctor puts the tube into a blood vessel and guides it to the tricuspid valve. The replacement valve goes through the tube and into the existing biological valve.

If tricuspid valve disease is due to a heart condition present at birth, several other treatments or surgeries may be needed.

Talk with your healthcare team about all your treatment options. Together you can decide which treatment is best for you.

If a healthcare professional thinks you might have tricuspid valve disease, you are usually sent to a doctor trained in heart diseases. This type of doctor is called a cardiologist. If you were born with a heart condition, you may see a heart doctor called a congenital cardiologist.

Here's some information to help you get ready.

What you can do

• When you make the appointment, ask if there's anything you need to do in advance. For example, you may be told not to eat or drink for a short period before some blood or imaging tests.
• Write down your symptoms, including any that seem unrelated to tricuspid valve disease.
• Write down important personal information, including a family history of heart valve disease, and any major stresses or recent life changes.
• Make a list of all the medicines, vitamins and supplements that you take. Include those bought without a prescription. Also include the dosages.
• Take someone with you, if possible. Someone who goes with you can help you remember information you're given.
• Write down questions to ask the healthcare team.

For tricuspid valve disease, some basic questions to ask your care team are:

• What's the most likely cause of my symptoms?
• What tests do I need? How do I need to prepare for these tests?
• I feel OK. Do I need treatment?
• What's the best treatment?
• What are the options to the treatment that you're suggesting?
• I have other health conditions. How can I best manage them together?
• Do I need to change my diet or activities?
• Should I see a specialist?
• If I need heart valve surgery, which surgeon do you recommend?
• Is there any printed information that I can take home with me?
• What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your healthcare team is likely to ask you many questions. Being ready to answer them may save time to go over any questions or concerns you want to spend more time on.

Your care team may ask:

• When did you first have symptoms?
• Do you always have symptoms or do they come and go?
• How bad are your symptoms?
• What, if anything, makes your symptoms better?
• What, if anything, makes your symptoms worse?