Tricuspid and Pulmonary Valve Disease

What are these valves?

The tricuspid valve lies between the right atrium and right ventricle. The pulmonary valve lies between the right ventricle and pulmonary artery. Together, they help direct blood through the right side of the heart towards the lungs.

A valve may become narrowed (stenosis) or fail to close fully (regurgitation). Significant disease can increase the workload of the right heart and eventually contribute to right-sided heart failure.

Tricuspid regurgitation

Tricuspid regurgitation is backward flow from the right ventricle to the right atrium during contraction. Mild regurgitation is common and does not always indicate important disease.

What causes it?

Primary regurgitation arises from the valve itself, for example congenital abnormalities, infection or rheumatic disease. Secondary regurgitation results from enlargement of the right ventricle, right atrium or valve ring. Pulmonary hypertension, left-sided heart disease and atrial fibrillation may contribute. Pacemaker or defibrillator leads can interfere with valve function in some patients.

What symptoms can occur?

Significant leakage may cause leg swelling, abdominal swelling, fatigue, reduced exercise capacity and fullness or discomfort in the upper abdomen.

How is it treated?

Treatment includes managing the underlying cause and relieving congestion with diuretics when appropriate. Severe regurgitation may require surgical repair or replacement, or catheter-based treatment in selected patients. Timing depends on symptoms, right ventricular function, associated disease and anatomy.

Tricuspid stenosis

Tricuspid stenosis restricts blood flow from the right atrium to the right ventricle. It is uncommon and may be associated with rheumatic disease or congenital abnormalities. Symptoms can include fatigue, abdominal discomfort and fluid retention.

Echocardiography measures valve opening, pressure gradients and associated abnormalities. Treatment may involve medical management of congestion and, in selected patients, a valve procedure.

Pulmonary stenosis

Pulmonary stenosis narrows the exit from the right ventricle to the pulmonary artery. It is most often congenital. Mild disease may cause no symptoms; more severe disease may cause breathlessness, fatigue, chest discomfort or fainting.

Diagnosis is usually made by echocardiography. Suitable valvular stenosis may be treated with balloon pulmonary valvuloplasty. Other anatomical forms may require surgery.

Pulmonary regurgitation

Pulmonary regurgitation allows blood to return from the pulmonary artery to the right ventricle. It may occur after treatment of congenital heart disease, with pulmonary hypertension or with other valve abnormalities.

Significant regurgitation may enlarge the right ventricle and cause reduced exercise tolerance or arrhythmias. Echocardiography and, when needed, cardiac MRI assess severity and right ventricular size and function. Valve replacement, surgical or transcatheter, may be considered in selected patients.

How are right-sided valve diseases evaluated?

Clinical examination and echocardiography are central. ECG, rhythm monitoring, cardiac MRI, CT or catheter assessment may be appropriate for specific questions. Severity is determined from several findings together.

Is every valve leak dangerous?

No. A small leak may be an incidental finding. Important factors include the cause, severity, symptoms, chamber size and heart function. Regular follow-up helps identify progression before irreversible right ventricular damage develops.

When should you seek care?

Increasing leg or abdominal swelling, new breathlessness, palpitations or reduced exercise capacity warrants assessment. Fainting, severe chest pain or sudden severe breathlessness requires emergency care. Call 112.

Assoc. Prof. Sezen Bağlan Uzunget, MD — Cardiologist

This information is educational. Management depends on the individual valve abnormality and clinical findings.

Türkçe: Triküspit ve Pulmoner Kapak Hastalıkları