Tricuspid valve disease affects the valve located between the right ventricle and right atrium, the two heart chambers. The tricuspid valve allows for the forward flow of blood from the right atrium to the ventricle but when it is diseased this flow of blood becomes either restricted or flows back though the valve in the wrong direction. When the flow of blood is restricted, this is referred to as tricuspid valve stenosis and means that the leaflets of the valve are not opening properly due to stiffening or calcification. When the valve no longer closes properly allowing for the flow of blood back through into the heart’s right atrium, this is referred to as tricuspid valve regurgitation.
Valve disease affecting the tricuspid valve can be caused by an infection such as rheumatic fever or infective endocarditis, an enlargement of the annulus - a ring of fibrous tissues that supports the leaflets of the valve - which results from a dilated right ventricle when the valve is under increased pressure often a result of pulmonary hypertension and other less common causes such as congenital defects, carcinoid heart disease, prolapse, trauma, Ebstein’s anomaly, systemic lupus or tumour. It is also common for tricuspid valve disease to be seen in combination with other valve diseases like aortic or mitral valve disease.
Tricuspid valve disease is less common than aortic and mitral valve disease. In Bernard Prendergast’s OxValve study 2.7% had a new diagnosis of mod/ severe tricuspid regurgitation compared to 6.4% having mod/ severe aortic or mitral valve disease. While it is less common than valve diseases found on the left side of the heart, tricuspid regurgitation is currently the subject of research into optimal therapies and treatment options.
Symptoms of tricuspid valve disease can sometimes be difficult to pinpoint. These can include atrial fibrillation or and irregular heart rhythm, tiredness, shortness of breath, discomfort or fluttering in the neck. The diagnosis of tricuspid valve disease often starts with a stethoscope examination where a doctor will listen for the telltale murmur associated with any form of valve disease. The doctor will also look for abnormalities in a patient’s pulse or heartbeat. If the doctor detects either or both of these signs, they will then refer you for further testing which can include an Echocardiography exam or transesophageal echocardiography.
Tricuspid valve disease is a treatable disease if it is detected early enough. Treatment often begins when your doctor places the patients on a monitoring schedule and ensures they receive regular appointments to determine the severity of their valve disease. Appointments will include a medical examination and further echocardiography tests that will help the cardiology team monitor the progression of the disease in order to determine the correct time for an intervention.
When the disease reaches severe levels, the cardiology team will prepare the patient for treatment which could include either a repair of the valve or a replacement. Your cardiothoracic surgeon will discuss the treatment options with you and they will work together with you and their colleagues to decide on the best course of treatment. In some cases, a repair is the best option. A repair can involve either a reshape of the valvular tissue, repairs or patches to any holes or tears or separating the valve leaflets that are fused together or calcified. Tricuspid valve repairs can either be performed using traditional open heart surgery (sternotomy) or through minimally invasive techniques depending on the patient.
For tricuspid valves that need to be replaced, the cardiothoracic surgeon will either replace the valve with a biological or tissue valve or a mechanical valve. A mechanical valve is a more traditional valve that is made of metal and as such the patient is required to take a blood thinner such as warfarin to ensure that the valve continues to function properly. A biological valve is made from tissue and does not require warfarin, however, unlike the mechanical valve, a tissue valve may need to be replaced in 10-15 years. As with the repair, tricuspid valve replacement is either performed via a sternotomy or minimally invasively depending on the patient.
Recovery often will involve a stay in the hospital. Depending on the treatment received and the overall health of the patient, the length of stay can vary from one day or two up to a week or more. Once a patient is sent home, they will have a few more days or weeks of recovery before they can continue their normal activities. For the first few days, activities like driving, exercise and lifting heavy objects will likely be restricted. Once everything is healed and the patient is given the all clear from their clinician, many patients who have received valve disease treatment find themselves feeling as though they have their quality of life back and are back to enjoying their favourite activities.
1. The Mayo Clinic. (2018). Tricuspid Valve Disease. [online] Available at: https://www.mayoclinic.org/diseases-conditions/tri... [Accessed: 18 February, 2019]
2. Clevland Clinic. (2019). Tricuspid Valve Disease. [online] Available at: https://my.clevelandclinic.org/health/diseases/175... [Accessed: 18 February, 2019]
3. The Society of Thoracic Surgeons. (2016). Tricuspid Valve Disease. [online] Available at: https://my.clevelandclinic.org/health/diseases/175... [Accessed: 18 February, 2019]