Tricuspid Valve Disease - Types, Symptoms, Diagnosis, and Treatment

Introduction:

Tricuspid valve disease is a condition where the valve is situated between the right atrium and right ventricle of the heart. The valve may be stiff or narrow (stenosis), leak (regurgitation), and be formed incorrectly at birth (atresia). Over time the symptoms of this condition can cause heart damage. In most cases, tricuspid valve disease cannot be prevented. But seeking the proper treatment at an early stage and following the doctor’s instructions can help in managing the condition. Untreated cases of tricuspid valve disease often have a poor prognosis.

What Is Tricuspid Valve Disease?

Tricuspid valve disease is a condition of the heart that affects a valve situated between the right atrium and right ventricle. The heart has four chambers called the right atrium, right ventricle left ventricle, and left atrium. The tricuspid valve located between the right side chambers of the heart is one of the four valves of the heart, namely, the mitral valve, tricuspid valve, pulmonary valve, and aortic valve. The tricuspid valve opens and closes in a coordinated fashion to make sure that the blood flows in the right direction from the right atrium to the right ventricle. This enables efficient pumping of the blood from the right side of the heart to the lungs for adequate oxygenation. When this function is impaired, tricuspid valve disease occurs. In severe cases, surgical repair or replacement of the valve may be required to prevent complications, relieve the symptoms, prolong survival, and improve the quality of life.

What Are the Types of Tricuspid Valve Disease?

The types of tricuspid valve disease are:

• Tricuspid Valve Regurgitation - Tricuspid valve regurgitation occurs when the tricuspid valve does not close properly or tightly enough. Due to this, the blood leaks backward through the valve whenever the right ventricle contracts. The amount of blood in the atrium increases because of this leakage. This buildup of blood in the atrium can enlarge it and change the pressure in the heart and blood vessels, causing heart damage.

• Tricuspid Atresia - It is a birth defect in an infant who has a solid piece of tissue in place of the tricuspid valve. This tissue limits blood flow and affects the development of the right ventricle. This condition can be corrected through surgery.

• Tricuspid Valve Stenosis - Tricuspid valve stenosis occurs when the tricuspid valve is too narrow or stiff. Due to this, the blood flow is restricted between the two chambers of the heart. The right atrium is enlarged over time, affecting the blood flow and pressure. This condition can decrease the amount of blood that circulates through the lungs and the rest of the body.

What Is the Etiology of Tricuspid Valve Disease?

There are several things that can cause tricuspid valve disease, including:

• Enlarged right ventricle.

• Congenital defects like Ebstein's anomaly (tricuspid valve is placed in the wrong position with malformed valve flaps).

• Infections like endocarditis (infection of the inner lining of the heart) or rheumatic fever.

• Carcinoid syndrome (a cancerous tumor that secretes certain chemicals into the bloodstream).

• Systemic health conditions like rheumatoid arthritis (an inflammatory disorder that affects the joints, including the joints of hands and feet), Marfan syndrome (an inherited disorder affecting the connective tissue), or lupus (a condition that occurs when the immune system attacks its own tissues).

• Medications such as Fenfluramine and Phentermine.

• Pulmonary hypertension (increased blood pressure affecting the arteries in the lung and the heart).

• Injury or trauma such as damage from myocardial biopsy, pacemaker, or heart attack.

What Are the Signs and Symptoms of Tricuspid Valve Disease?

The signs and symptoms of tricuspid valve disease differ among patients. Some people with mild cases show no signs and symptoms, while those with moderate to severe cases might have noticeable symptoms like:

• Weakness or fatigue.

• Abnormal heart rhythm.

• Swelling in the abdomen, legs, ankles, or feet.

• Heart murmur.

• Fluttering or pulsating feeling in the chest or neck.

• Shortness of breath.

• Enlarged liver (hepatomegaly).

• Abnormally cold skin.

How to Diagnose Tricuspid Valve Disease?

To diagnose tricuspid valve disease, the doctor will ask about the symptoms and medical history and conduct a physical examination which involves feeling the veins in the neck, listening to the heart with a stethoscope, and taking the blood pressure.

• Echocardiogram - It is the most common diagnostic test to diagnose tricuspid valve disease. This test provides detailed ultrasound imaging of the heart. The transducer or sound device may be inserted into the esophagus called a transesophageal echocardiogram or placed on the chest wall called a transthoracic echocardiogram.

• Electrocardiogram - In this test, the electrodes are used to record the electrical signals from the heart to evaluate irregularities in the heart.

• Chest X-ray - This test uses a small dose of ionizing radiation to create an image of the heart and nearby structures. It helps to check the size of the heart and other findings suggestive of tricuspid valve disease.

• Heart MRI (Magnetic Resonance Imaging) - This test uses a powerful magnetic field, radio waves, and a computer to produce a comprehensive image of the heart and nearby blood vessels.

• Cardiac Catheterization - It is a diagnostic method that uses a thin, flexible tube known as a catheter. The catheter is inserted through a blood vessel into the heart, and it evaluates the abnormalities suggestive of tricuspid valve disease. This method also helps in the treatment of the condition.

What Are the Treatment Options for Tricuspid Valve Disease?

The management of tricuspid valve disease depends on the severity of the condition, the symptoms, and the underlying cause.

1) Medications - Certain medicines are prescribed to relieve the symptoms and prolong survival. The medicines include:

• Antiarrhythmic medications.

• Angiotensin-converting enzyme (ACE) inhibitors.

• Digoxin (used to treat heart failure).

• Anticoagulants.

• Diuretics (used to remove the extra fluid from the body).

2) Surgery - Surgical options include tricuspid valve repair or replacement. The tricuspid valve repair involves inserting a synthetic annuloplasty ring that helps in tightening and stabilizing the existing valve. Tricuspid valve replacement involves the removal of the existing damaged valve and the insertion of a new mechanical or biological valve. Insertion of the mechanical valve requires life-long treatment with blood-thinning medicines to prevent blood clot formation on the valve. These surgical options can be done by minimally invasive approaches like robotic-assisted techniques. With all surgical procedures, there are risks of infection, bleeding, blood clot formation, and prolonged pain after the operation.

Conclusion:

Tricuspid valve disease is a heart condition involving the tricuspid valve located in between the right side chambers of the heart. It occurs when the function of the tricuspid valve is impaired. Mild tricuspid valve disease may not show any signs or symptoms. But moderate to severe cases show noticeable symptoms that, if left untreated, may lead to heart damage. The treatment involves medicines and surgical procedures.