Tricuspid valve regurgitation (TVR) is a heart condition where the tricuspid valve, located in the heart, does not close properly. This malfunction allows blood to leak backward into the heart’s upper right chamber.
Understanding Tricuspid Valve Regurgitation
The tricuspid valve resides between the right atrium, the upper right chamber, and the right ventricle, the lower right chamber. Its function involves opening to permit blood flow from the right atrium into the right ventricle and then closing tightly to prevent blood from flowing backward during the heart’s contraction.
When tricuspid regurgitation occurs, the valve’s leaflets do not seal completely, leading to a backflow of blood into the right atrium with each heartbeat. This means less blood is effectively pumped forward to the lungs for oxygenation. Consequently, the heart must work harder to maintain adequate blood flow, reducing circulatory efficiency.
The Prevalence of Tricuspid Valve Regurgitation
Tricuspid valve regurgitation is a common finding, with its prevalence varying significantly based on severity and age. Mild or “trace” forms are common and often harmless, frequently detected incidentally during imaging tests. They are found in a significant percentage of healthy adults, with some reports suggesting detection in up to 75% during routine echocardiography. This physiological or trivial regurgitation causes no symptoms and does not lead to complications.
The prevalence of moderate-to-severe tricuspid regurgitation, which can have clinical implications, is considerably lower. In the U.S., it affects between 5 and 8 out of every 1,000 people. Its occurrence increases with age, estimated to affect 4% of the population over 75 years of age. While mild forms are widespread and benign, severe forms are less frequent and associated with symptoms and adverse outcomes.
Causes and Factors Contributing to Tricuspid Valve Regurgitation
Tricuspid valve regurgitation develops from primary and secondary causes. Primary tricuspid regurgitation directly involves structural abnormalities or damage to the tricuspid valve itself. Examples include congenital heart defects (like Ebstein’s anomaly), rheumatic heart disease, infective endocarditis, damage from certain medications or chest trauma, and issues with implanted devices like pacemaker leads traversing the valve.
Secondary, or functional, tricuspid regurgitation is the most common form, accounting for the majority of cases. This type occurs when underlying conditions cause the right ventricle to enlarge and stretch the valve annulus (the ring supporting the valve leaflets). Conditions like pulmonary hypertension, left-sided heart failure (including left ventricular dysfunction or mitral valve disease), and chronic lung disease can lead to increased pressure or volume in the right side of the heart, causing the right ventricle to dilate. This enlargement pulls the valve leaflets apart, preventing them from closing properly even if the leaflets themselves are structurally normal.
Recognizing and Diagnosing Tricuspid Valve Regurgitation
Mild tricuspid regurgitation presents without any noticeable symptoms. However, as the condition progresses to moderate or severe forms, individuals may experience symptoms because the heart must work harder to circulate blood effectively. Common symptoms include extreme tiredness, shortness of breath (especially during physical activity), swelling in the legs, ankles, or abdomen, a pounding or rapid heartbeat, or a pulsing sensation in the neck veins.
Diagnosis begins with a physical examination where a healthcare professional listens for a heart murmur, a whooshing sound indicating abnormal blood flow through the valve. The primary diagnostic tool is an echocardiogram, an ultrasound of the heart, which provides detailed images of the heart’s structure and function, assessing valve function and regurgitation severity. Other tests, such as an electrocardiogram (EKG) to check the heart’s electrical activity or a chest X-ray to evaluate heart and lung size, may also be used to assess overall heart health and potential underlying causes.