Tricuspid Valve Regurgitation – Is Heart Valve Surgery Necessary?

Tricuspid Valve Regurgitation begins when one or more of the three valve leaflets fail to close effectively.

The medical literature also refers to tricuspid regurgitation as tricuspid incompetence and tricuspid insufficiency, but it is more commonly referred to simply as a leaky heart valve.

Fortunately, most regurgitating tricuspid valves require no treatment. They do not progress to the acute symptomatic stages. By far, most people with this valvular disorder go about their lives never knowing about their malfunctioning tricuspid valve.

Tricuspid regurgitation is usually caused by heart disorders that enlarge the right ventricle, as the right ventricle enlarges, the tricuspid valve stretches, causing regurgitation.

However, less frequently, pacemaker and defibrillator lead extraction complications can cause severe regurgitation of the tricuspid valve. The leads can become entangled in the valve leaflets, or they can, over time, adhere to one of the leaflets.

When the lead or leads are extracted, the valve can be severely damaged necessitating open heart surgery to repair the damage. Sometimes the valve is so severely damaged that it can’t be repaired. In those cases, a valve replacement surgery is needed.

Many times the damage to the valve can go undetected until the patient becomes severely symptomatic. Often tricuspid regurgitation (TR) patients experience neck pulsations and sometimes, depending upon the severity of the regurgitation, large bulbous areas can be seen in the neck veins.

Other symptoms can be rapid progression of weakness to the point of difficulty in standing; fluid retention in the stomach, legs, and lower extremities; breathlessness; fainting; atrial fibrillation or flutter; and even congestive heart failure.

If you begin to experience any of these symptoms, get yourself to your Doctor or emergency clinic. After taking your history, your Doctor will listen to your heart with a stethoscope.

If you have significant valve leakage, a murmur can be heard. This murmur, “whooshing” sound, alerts the Doctor that there is a need for tests to determine the severity of your heart valve disorder.

You will, more than likely, be referred to a cardiologist, a doctor specializing in heart disorders and diseases. The cardiologist has an entire battery of tests at his disposal to help him or her determine exactly what is wrong with your heart.

The most important test for diagnosing heart valve regurgitation is an echocardiogram (heart echo). But, a chest x-ray and electrocardiogram (EKG) may also be used first to see if signs of a leaking valve are present. If they are present, echocardiography is usually ordered to confirm the diagnosis.

Other tests that may be used to assess how severe your heart valve disorder is are cardiac catheterization (heart cath), cardiac MRI, and stress testing. Undergoing these tests, while inconvenient for you, will help your cardiologist develop the best plan for your treatment.

If it is determined that you need valve surgery, the odds are overwhelmingly in your favor. Globally, some 250,000 heart valve surgeries are performed every year.

With today’s new heart valve surgery advancements, heart valve repair and replacement surgeries are almost routine to the cardiothoracic surgeons that specialize in them. The mortality rate now stands at between 2% to 5%, but those numbers continue to improve.