Tricuspid Regurgitation Treatment in Delhi, India

Tricuspid Regurgitation (TR) is a heart valve disorder in which the tricuspid valve (located between the right atrium and right ventricle) does not close properly, allowing blood to flow backward into the right atrium when the right ventricle contracts. This condition can lead to an enlarged right atrium, increasing pressure in the veins.

The heart valve condition is classified into the following five types based on its cause and severity:

Primary (Organic) Tricuspid Regurgitation

When the tricuspid valve does not close properly due to structural abnormalities of the valve apparatus, blood flows backward from the right ventricle into the right atrium. This condition is known as primary (or organic) tricuspid regurgitation (TR).

Secondary (Functional) Tricuspid Regurgitation

More common than primary tricuspid regurgitation, this type of TR occurs when the tricuspid valve fails to close properly due to changes in the right ventricle (RV) or surrounding structures. This leads to backflow of blood into the right atrium during systole.

Acute Tricuspid Regurgitation

This disorder occurs when blood leaks backward suddenly in the heart through the tricuspid valve. It can result in rapid hemodynamic deterioration due to increased right atrial pressure and reduced cardiac output. Common causes of acute TR include blunt chest trauma, papillary muscle failure, and carcinoid syndrome.

Congenital Tricuspid Regurgitation

As the name suggests, this type of TR is present at birth. It occurs when the tricuspid valve (located between the right atrium and right ventricle) does not close properly, leading to backflow of blood into the right atrium during ventricular contraction. This can result in volume overload, right atrial enlargement, and right heart dysfunction over time.

Pacemaker or ICD Lead-Induced Tricuspid Regurgitation

Pacemaker leads can interfere with the function of the tricuspid valve, leading to valvular insufficiency. This condition can lead to right ventricular volume overload, right atrial enlargement, systemic venous congestion, and secondary pulmonary hypertension.

In most cases, TR is caused by intrinsic structural abnormalities of the valve apparatus. Sometimes, a condition leading to RV overload or dysfunction can cause the heart valve disease. Here are some common TR causes:

Congenital Heart Defects

Eibstein’s anomaly, a rare congenital heart defect that affects the structure of the tricuspid valve can cause TR. The condition results in the displacement of the tricuspid valve, leading to poor leaflet coaptation and severe regurgitation. Some congenital heart defects can lead to abnormal development of the tricuspid valve leaflets, chordae, or papillary muscles preventing proper closure of the TR valve.

Rheumatic Heart Disease

Rheumatic Heart Disease (RHD) causes mitral stenosis (MS) or mitral regurgitation (MR), often leading to RV dilation and tricuspid annular dilation, which causes secondary (functional) TR. Left-sided heart disease (MS, MR) caused by RHD can prevent proper leaflet closure, leading to TR.

Chronic Lung Disease

Lung diseases such as COPD, interstitial lung disease and pulmonary fibrosis can lead to right ventricular (RV) pressure overload, causing RV dilation and dysfunction. Some chronic lung conditions can cause right atrial enlargement, worsening TR symptoms.

Carcinoid Syndrome

Carcinoid tumors in the small intestine release serotonin, bradykinin, histamine, and tachykinins into the bloodstream. If cancerous tumours develop in the liver, serotonin reaches the heart. High levels of serotonin lead to fibrosis, preventing proper closure during systole, causing tricuspid regurgitation.

Atrial Fibrillation

Atrial fibrillation results in right atrial dilation, which stretches the tricuspid annulus (ring), causing it to close improperly. This leads to functional TR. Chronic AF causes progressive dilation of the tricuspid annulus, leading to regurgitation.

People at high risk of developing the heart valve condition should watch out for the following TR risk factors and come up with a plan to manage them.

Endocarditis

Infective endocarditis (IE) can cause valve leaflet perforation, damaging the tricuspid valve. As a result, it closes improperly, allowing blood to flow backwards into the right atrium. In severe cases, endocarditis can lead to the formation of abscesses around the valve annulus. As the abscesses heal, scar tissue and fibrosis may develop, leading to valve retraction and annular dilation.

Pulmonary Hypertension

PH makes it harder for the right ventricle to pump blood into the lungs, causing right ventricular hypertrophy and dilatation, which pulls the tricuspid valve leaflets apart. In people already living with TR, pressure overload may cause structural changes in the tricuspid valve, further worsening TR symptoms over time.

Obesity

Obesity causes an increase in circulating blood volume, putting extra strain on the right ventricle (RV). Volume overload can lead to RV dilation and dysfunction, causing functional TR. The chronic health condition is associated with chronic systemic inflammation, which contributes to myocardial fibrosis and dysfunction, further exacerbating right ventricular impairment.

Certain Medications

Some medications such as cabergoline, bromocriptine, and fenfluramine can cause fibrotic changes in the heart valves, leading to TR. In people with TR, medications that promote fluid retention can exacerbate the symptoms of heart valve disease by increasing right ventricular preload.

Radiation Therapy

Radiation can cause progressive fibrosis, leading to thickening and calcification of the tricuspid valve leaflets. This can affect leaflet motion, preventing proper closure and causing regurgitation. Radiation can also lead to TR by causing annular dilation.

Right Ventricular Weakness

Any condition that weakens the right ventricle (e.g., left heart failure, chronic lung disease) can lead to TR. When the right ventricle weakens and contracts poorly, it may fail to generate the necessary force to close the tricuspid valve effectively, leading to regurgitation.

TR symptoms can vary from mild to severe depending on the severity of the condition. People living with heart valve disorder should come up with a plan to manage their symptoms. Some common TR symptoms include:

Fatigue and Weakness

When the tricuspid valve does not close properly, the heart struggles to circulate blood. As a result, the body receives less oxygen-rich blood. This leads to persistent fatigue and weakness, which makes even routine activities feel exhausting.

Swelling (Edema)

TR causes blood to back up in the venous system, allowing fluid to leak into surrounding tissues. Fluid retention leads to swelling in the legs, ankles, feet, and even the abdomen (ascites). Swelling caused by TR usually does not go on its own.

Shortness of Breath (Dyspnea)

In severe cases, increased fluid buildup in the lungs can lead to shortness of breath. This TR symptom may worsen with physical activity or when lying flat. Shortness of breath caused by tricuspid regurgitationcan be mild to severe, depending on the severity of the condition.

Abdominal Discomfort

Liver congestion due to blood backing up from the right side of the heart can lead to discomfort or pain in the upper right abdomen, often accompanied by a feeling of fullness or bloating.

Pulsations in the Neck (Jugular Venous Distension)

As blood backs up into the neck veins, it can cause noticeable pulsations in the neck, which may become more pronounced when lying down. In severe cases, the backflow of blood into the right atrium can cause more prominent neck pulsations.

Physicians conduct clinical evaluations and may order imaging tests to diagnose TR. Advanced diagnostic methods, such as cardiac MRI or catheterization, may also be employed in certain cases.

Clinical Evaluation

During a physical examination conducted to diagnose TR, the physician examines the patient’s heart using a stethoscope. The healthcare professional also observes the jugular vein in the patient’s neck (for distension) and looks for signs of peripheral edema (swelling in the legs and abdomen).

Echocardiography

Transthoracic echocardiogram (TTE) and transesophageal echocardiogram (TEE) are two common types of echocardiography physicians use to diagnose TR. TTE utilises ultrasound to visualise the tricuspid valve and measure blood flow. TEE uses a probe placed in the esophagus to generate a clear image of the heart.

Chest X-ray

A chest X-ray can help a doctor identify secondary changes in the heart and lungs caused by TR. While it cannot directly visualize the tricuspid valve, a chest X-ray helps in diagnosing right heart enlargement and congestion.

Electrocardiogram

An electrocardiogram (ECG or EKG) can help a physician identify indirect signs of right heart strain, enlargement, or arrhythmias associated with TR. A major shortcoming of ECG is that it cannot directly visualize valvular abnormalities.

Cardiac MRI

CMR allows for measurement of blood flow across the tricuspid valve, helping differentiate between mild, moderate, and severe TR. It offers various advantages and can help doctors accurately measure RV volume and assess RV function.

Depending on the severity of a patient’s condition, their symptoms and overall health, and underlying cause of TR, their doctor may use one or more of the following TR treatment options:

Medication

While medicines for TR do not treat its underlying cause, they can help manage TR symptoms. The heart valve condition can force the right ventricle to work harder, increasing the heart’s workload. Vasodilators can help reduce the heart’s workload.

Diuretics such as furosemide and torsemide can help manage fluid buildup and swelling associated with TR.

Surgery

In severe cases, doctors may perform a surgical procedure to repair or replace the tricuspid valve. To repair a leaking tricuspid valve, a surgeon usually performs an annuloplasty. If a patient’s valve leaflets are prolapsed, their doctor may perform a surgery to repair them. When the TR valve is damaged beyond repair, a mechanical or bioprosthetic valve can be implanted.

Transcatheter Therapies

In case of high-risk surgical patients, doctors use the PASCAL implant to clip the valve leaflets together. If valve repair is not possible, a catheter-based approach to replace the tricuspid valve may be adopted.

Management of Underlying Conditions

Several health conditions including left-sided heart disease and pulmonary hypertension can cause damage to the TR valve. When these conditions are managed effectively, TR symptoms significantly improve.

Left-sided Heart Disease

Conditions such as mitral regurgitation and aortic stenosis can affect the right heart, leading to right ventricular (RV) dilation. Doctors use medical therapy or perform surgeries to treat mitral or aortic valve disease.

Pulmonary Hypertension 

Increased pressure in the pulmonary arteries forces the right ventricle to work harder, leading to tricuspid annular dilation. Pulmonary vasodilators such as phosphodiesterase-5 inhibitors and endothelin receptor antagonists can help reduce pressure on the pulmonary artery, relieving TR symptoms.

Individuals born with a healthy heart can reduce their risk of developing the heart valve condition by following these simple steps.

Maintain a Healthy Lifestyle

High blood pressure can lead to heart enlargement and valve dysfunction.People with hypertension should add heart-healthy foods such as fruits, vegetables, whole grains, eggs, beans, and nuts to their diet. They must steer clear of foods high in sodium and sugary treats for a healthy heart.

Prevent and Manage Heart Conditions

Health conditions such as mitral valve disease, pulmonary hypertension, and atrial fibrillation can increase pressure on the right side of the heart, leading to TR. People diagnosed with these and other health conditions that affect the heart should come up with a plan to manage their symptoms.

Take Steps to Prevent Infective Endocarditis

Usually caused by a bacterial infection, endocarditis can inflame the inner lining of the heart’s valves and chambers, damaging the tricuspid valve. Poor oral hygiene allows bacteria to enter the bloodstream and infect heart valves. By practicing good oral hygiene, one can reduce their risk of infective endocarditis.

Realise the Importance of Regular Health Check-ups

People with a heart condition should see their doctor regularly. During a patient appointment, a physician may perform a physical examination to check heart health. They may also want to take a look at the patient’s echocardiogram report to check if the heart valve is working properly.

Manage Risk Factors for Heart Disease

To keep their heart healthy and happy one should quit alcohol and stop smoking . People living with diabetes should take steps to lower blood sugar levels. Individuals at high risk of developing TR should steer clear of drugs such as cocaine and methamphetamine.

1. Can tricuspid regurgitation go away on its own?

Mild cases may not require treatment and can remain stable. However, moderate to severe cases typically worsen over time and need medical intervention.

2. What lifestyle changes can help manage tricuspid regurgitation?

Maintaining a heart-healthy diet, limiting salt intake, avoiding excessive alcohol, managing blood pressure, and staying physically active (as advised by a doctor) can help manage symptoms.

3. Can I exercise if I have tricuspid regurgitation?

Light to moderate exercise may be safe, but strenuous activities should be avoided if the condition is severe. Always consult a cardiologist before starting an exercise routine.

4. How does tricuspid regurgitation affect daily life?

Mild cases may not impact daily activities, but severe cases can cause fatigue, swelling, and breathlessness, limiting physical exertion and overall quality of life.

5. Is tricuspid regurgitation a lifelong condition?

It depends on the severity. Mild cases may not progress significantly, while moderate to severe cases may require lifelong monitoring or intervention.

6. Can tricuspid regurgitation lead to heart failure?

Yes, in severe cases, the condition can strain the right side of the heart, leading to heart failure if left untreated.

7. What is the life expectancy of someone with tricuspid regurgitation?

Life expectancy varies based on severity, overall heart health, and timely treatment. With proper management, many patients can lead normal, fulfilling lives.

8. Does tricuspid regurgitation always get worse over time?

Not always. Some cases remain mild and stable, but progressive forms can worsen, especially if linked to conditions like heart disease or pulmonary hypertension.

9. Can tricuspid regurgitation recur after treatment?

Yes, in some cases, especially if there are underlying conditions or if the valve repair/replacement is affected by complications. Regular follow-ups are essential.

10. Are there medications to cure tricuspid regurgitation?

Medications can help manage symptoms and underlying conditions, but they do not cure the valve disorder itself.

11. Can home remedies or alternative therapies help?

While lifestyle changes like reducing salt intake can help manage symptoms, there is no alternative therapy that can cure or reverse tricuspid regurgitation.

12. How long does it take to recover from tricuspid valve surgery?

Recovery time varies but typically ranges from a few weeks to a few months, depending on the procedure and overall health of the patient.

13. Will I need a pacemaker after tricuspid valve surgery?

Some patients may require a pacemaker if the surgery affects the heart’s electrical system, but this is not always necessary.

14. Is minimally invasive surgery an option for tricuspid regurgitation?

Yes, transcatheter valve procedures and other minimally invasive techniques may be suitable for some patients, depending on their condition.

15. Can tricuspid regurgitation affect pregnancy?

Yes, severe cases can pose risks during pregnancy due to increased blood volume and heart strain. Women with tricuspid regurgitation should consult a cardiologist before planning a pregnancy.

16. Is tricuspid regurgitation considered a disability?

It depends on severity. Mild cases may not impact daily life, but severe cases leading to heart failure or breathlessness may qualify for disability benefits in some cases.

17. Can I fly or travel long distances with tricuspid regurgitation?

Most people with mild or moderate cases can travel without issues, but those with severe conditions should consult their doctor, especially for long-haul flights.

18. What foods should I avoid if I have tricuspid regurgitation?

Reducing salt, processed foods, excessive caffeine, and alcohol can help manage fluid retention and heart strain.

19. Can stress worsen tricuspid regurgitation?

Yes, chronic stress can elevate blood pressure and worsen symptoms. Managing stress through relaxation techniques and a balanced lifestyle is beneficial.

20. How often should I see a doctor for tricuspid regurgitation?

This depends on severity. Mild cases may need annual checkups, while moderate to severe cases require more frequent monitoring.

Reviewed By Dr. Rajneesh Malhotra, Vice Chairman & Head - CTVS, Cardiac Sciences, Cardiac Surgery (CTVS), Robotic Surgery, on 26 March 2025.