Tricuspid valve disease

Tricuspid regurgitation is characterised by regurgitation from the ventricle into the right atrium. It may lead to dilatation and subsequently failure of the right-sided chambers of the heart (the right atrium and ventricle). The causes may be functional (common) or organic (rare).

In the former case, regurgitation is secondary to incomplete leaflet coaptation because the tricuspid annulus is dilated as a result of increased pressure caused by a downstream obstruction (in the pulmonary circulation, at the mitral valve, etc.). This may occur in the context of pulmonary hypertension, mitral-aortic valve disease, ischaemic heart disease, cor pulmonale (chronic respiratory conditions increasing resistance to right ventricular ejection into the pulmonary vessels), or acute or chronic pulmonary embolism.
Organic causes of tricuspid valve damage are rarer; these include certain congenital malformations, bacterial endocarditis, acute rheumatic fever, chest trauma, right ventricular infarction and carcinoid syndrome.

The patient generally presents with signs of right-sided heart failure: oedema of the lower limbs, hepatomegaly, distended jugular veins or, in cases of global heart failure, dyspnoea or fatigue.

Treatment is initially medical. Surgery is indicated in cases of functional tricuspid regurgitation associated with mitral valve disease, tricuspid valve infection that does not respond to antibiotics, or symptomatic severe tricuspid regurgitation. Usually, tricuspid valve repair by annuloplasty is performed; more rarely, the valve needs to be replaced.