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Tricuspid Regurgitation

(Tricuspid Incompetence; Tricuspid Insufficiency)


Guy P. Armstrong

, MD, Waitemata District Health Board and Waitemata Cardiology, Auckland

Reviewed/Revised Jul 2022 | Modified Sep 2022

Tricuspid regurgitation is leakage of blood backward through the tricuspid valve each time the right ventricle contracts.

  • Tricuspid regurgitation is caused by disorders that enlarge the right ventricle.

  • Symptoms are vague, such as weakness and fatigue.

  • Doctors make the diagnosis because of physical examination findings, and they use echocardiography to confirm the diagnosis.

  • The underlying disorder needs to be treated.

The tricuspid valve is in the opening between the right atrium and the right ventricle. The tricuspid valve opens to allow blood from the right atrium to fill the right ventricle and closes to keep blood from flowing back into the right atrium as the right ventricle contracts to pump blood into the lungs. When the tricuspid valve does not close completely, some blood leaks backward into the right atrium, termed regurgitation. (See also the video )

Blood leaking backward into the right atrium increases the volume of blood there and results in less blood being pumped through the heart and to the body. As a result, the right atrium enlarges, and blood pressure increases in the right atrium and the large veins that enter it from the body. This can sometimes cause symptoms of heart failure Heart Failure (HF) Heart failure is a disorder in which the heart is unable to keep up with the demands of the body, leading to reduced blood flow, back-up (congestion) of blood in the veins and lungs, and/or... read more Heart Failure (HF) . The liver and/or legs may swell because of this increased pressure.

An extremely enlarged atrium often beats rapidly in an irregular pattern (a disorder called atrial fibrillation Atrial Fibrillation and Atrial Flutter Atrial fibrillation and atrial flutter are very fast electrical discharge patterns that make the atria (upper chambers of the heart) contract very rapidly, with some of the electrical impulses... read more ), which reduces the heart's pumping efficiency because the fibrillating atrium is quivering rather than pumping. Consequently, blood does not flow through the atrium briskly, and blood clots may form inside the chamber. If a clot breaks loose (becoming an embolus), it is pumped out of the heart and may block an artery, possibly causing a stroke Overview of Stroke A stroke occurs when an artery to the brain becomes blocked or ruptures, resulting in death of an area of brain tissue due to loss of its blood supply (cerebral infarction). Symptoms occur suddenly... read more or other damage

Causes of Tricuspid Regurgitation

Unlike other heart valve disorders Overview of Heart Valve Disorders Heart valves regulate the flow of blood through the heart's four chambers—two small, round upper chambers (atria) and two larger, cone-shaped lower chambers (ventricles). Each ventricle has... read more Overview of Heart Valve Disorders , tricuspid regurgitation usually occurs in a normal valve that has been affected by other heart disorders. The most common cause is when the right ventricle enlarges and resistance to blood flow from the right ventricle to the lungs is increased. Resistance may be increased by

To compensate, the right ventricle enlarges, stretching the tricuspid valve and causing regurgitation.

Symptoms of Tricuspid Regurgitation

Tricuspid regurgitation usually causes no symptoms except sometimes pulsations in the neck due to the elevated right atrial pressure and discomfort in the right upper part of the abdomen due to an enlarged liver. Rarely, people have accumulation of fluid in the body (edema), mainly in the legs.

Diagnosis of Tricuspid Regurgitation

  • Echocardiography

The diagnosis is based on the person's medical history and results of a physical examination, often electrocardiography Electrocardiography Electrocardiography (ECG) is a quick, simple, painless procedure in which the heart’s electrical impulses are amplified and recorded. This record, the electrocardiogram (also known as an ECG)... read more Electrocardiography (ECG), and chest x-ray. Through a stethoscope, doctors may hear a characteristic murmur produced by the blood leaking backward through the tricuspid valve, but the murmur tends to disappear as the regurgitation worsens.

Treatment of Tricuspid Regurgitation

  • Treatment of underlying disorder

  • Sometimes valve repair or replacement

Usually, mild tricuspid regurgitation requires little or no treatment. However, the underlying disorder, such as emphysema, pulmonary hypertension, pulmonic stenosis, or abnormalities of the left side of the heart, is likely to require treatment. Treatment of atrial fibrillation and heart failure is also necessary.

Surgery to repair or replace the tricuspid valve is rarely done unless regurgitation is severe or surgery on another heart valve (for example, mitral valve replacement) is also needed. Surgery may involve sewing in a ring to reduce the size of the valve opening, repairing the valve, or replacing it with a prosthetic valve.

More Information

The following is an English-language resource that may be useful. Please note that THE MANUAL is not responsible for the content of this resource.

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