Tricuspid Valve Disease

Tricuspid Valve Disease: Regurgitation, Stenosis & Treatment

Tricuspid valve disease overview

Tricuspid valve disease means that the tricuspid valve, the valve between the right upper chamber (right atrium) and the right lower chamber (right ventricle) of the heart, is not working normally. Most often the valve leaks backwards (tricuspid regurgitation). Much less often it is narrowed (tricuspid stenosis).

What the tricuspid valve does

The tricuspid valve has three thin leaflets. It opens to let blood flow from the right atrium into the right ventricle, then closes as the right ventricle contracts so that blood is pushed forward to the lungs and not backwards. The right side of the heart collects blood returning from the body through the veins and sends it to the lungs to pick up oxygen.

When the valve leaks, some blood flows backwards into the right atrium and the veins of the body with every beat. The right-sided chambers can enlarge, and pressure builds up in the veins, particularly those of the liver, abdomen and legs. This is why tricuspid disease can cause swelling of the ankles and abdomen and tiredness, rather than the chest symptoms most people expect from a heart problem.

Tricuspid regurgitation and tricuspid stenosis

Tricuspid regurgitation (TR) – the valve does not close fully and blood leaks backwards. This is by far the commonest form. A trivial or mild leak is found in many healthy people and does not need treatment.
Tricuspid stenosis (TS) – the valve opens poorly and restricts blood flow into the right ventricle. It is rare in the UK and is usually caused by rheumatic heart disease, carcinoid syndrome or a congenital abnormality. It often occurs together with mitral valve disease.

How common is tricuspid valve disease?

In a large community study from Minnesota, tricuspid regurgitation of moderate or greater severity was found in about 0.55% of adults on echocardiography, and it became much more common with age and was more frequent in women (Topilsky et al., JACC Cardiovasc Imaging 2019). Mild tricuspid regurgitation is far more common and is often a normal finding.

Why it matters

A mild leak is usually harmless. Moderate or severe tricuspid regurgitation that continues for years can enlarge the right side of the heart, cause fluid retention and, in some people, right heart failure. The same study found that significant tricuspid regurgitation was associated with higher mortality, even in people without other heart disease. The good news is that the problem is now recognised and assessed much more carefully, and there are more treatment options than there were a few years ago.

Related heart valve conditions

Tricuspid disease commonly occurs alongside problems with the other heart valves. See our guides on heart valve disease, mitral valve regurgitation and mitral valve stenosis.

Tricuspid regurgitation and stenosis explained

Primary, secondary and isolated tricuspid regurgitation.

Diagram: Dr Salam Salloum, uk-cardiologist.co.uk. Classification after Prihadi et al., JACC Cardiovasc Imaging 2019;12:491-499.

Tricuspid valve problems are classified by what is wrong with the valve and how severe the problem is. This matters because the cause determines the treatment.

Primary and secondary tricuspid regurgitation

Primary (organic) tricuspid regurgitation – the valve itself is abnormal. Causes include Ebstein anomaly (a congenital abnormality), rheumatic heart disease, infection of the valve (endocarditis), carcinoid heart disease, prolapse or flail leaflets, injury to the valve and damage from a pacemaker or defibrillator lead. This accounts for a minority of cases.
Secondary (functional) tricuspid regurgitation – the valve leaflets are normal but the valve ring (annulus) has stretched or the leaflets are pulled apart because the right ventricle or right atrium has enlarged. This is the commonest form. It is caused by pulmonary hypertension, left-sided heart disease (such as mitral valve disease or left heart failure), long-standing atrial fibrillation (so-called atrial functional tricuspid regurgitation) or right ventricular disease.
Isolated tricuspid regurgitation – significant tricuspid regurgitation with no evidence of left-sided heart disease, pulmonary hypertension or another clear cause. It is frequently associated with atrial fibrillation and an enlarged right atrium (Prihadi et al., JACC Cardiovasc Imaging 2019).

Grades of severity

Echocardiography is used to grade tricuspid regurgitation. A five-grade scheme is now widely used, which adds two grades above severe to describe very large leaks that were previously all grouped together (Hahn and Zamorano, Eur Heart J Cardiovasc Imaging 2017):

Mild – a small leak; usually no treatment and little or no follow-up needed if the heart is otherwise normal.
Moderate – a larger leak; follow-up and treatment of the cause.
Severe – a large leak with enlargement of the right heart; assessment for intervention.
Massive and torrential – the two highest grades of severity, which carry the greatest effect on the right heart and the worst outlook if untreated.

Tricuspid stenosis

Tricuspid stenosis is graded by the pressure difference across the valve and the valve area on echocardiography. It is uncommon on its own and is most often found with rheumatic mitral valve disease. Many patients with tricuspid stenosis also have some tricuspid regurgitation.

What the grade does and does not tell you

The severity grade is only one part of the picture. Your symptoms, the size and pumping strength of the right ventricle, the pressure in the lung circulation, your heart rhythm and any left-sided valve disease all influence what is recommended. Two people with the same grade of leak can need very different advice.

Tricuspid valve disease symptoms and signs

Mild tricuspid regurgitation usually causes no symptoms and is found by chance on an echocardiogram. Symptoms generally appear only when the leak is moderate to severe, or when there is also left-sided heart disease or pulmonary hypertension.

Common symptoms

Swelling of the ankles and legs
Swelling or bloating of the abdomen, sometimes with a feeling of fullness and loss of appetite
Tiredness and reduced ability to exercise
Breathlessness, often because of a coexisting left-sided problem or heart failure
Discomfort or a dragging feeling under the right ribs, from a congested liver
A fluttering or pulsing sensation in the neck
Palpitations or an irregular heartbeat, particularly if you have atrial fibrillation

Symptoms that may be missed

The symptoms of tricuspid regurgitation develop slowly and are easily put down to age, weight gain or being unfit. Many people with significant tricuspid regurgitation are diagnosed late, when the right side of the heart is already enlarged and fluid has been building up for some time.

Signs your doctor may find

A heart murmur, heard best at the lower left edge of the breastbone, which often becomes louder on breathing in
Prominent, pulsating veins in the neck
An enlarged, tender or pulsating liver
Fluid in the abdomen (ascites)
Pitting swelling of the legs
An irregular pulse from atrial fibrillation

A murmur on its own does not mean valve disease. See our guide to the heart murmur.

Symptoms of tricuspid stenosis

Tricuspid stenosis causes similar symptoms: fatigue, swelling of the abdomen, legs and ankles, and a fluttering in the neck. Breathlessness is often milder, because the main problem is blood backing up into the veins and not the lungs.

Causes and risk factors of tricuspid valve disease

Most tricuspid regurgitation is a consequence of another problem in the heart or lungs. Finding the cause is the most important step, because treating it often reduces the leak or stops it getting worse.

Causes of secondary (functional) tricuspid regurgitation

Left-sided heart valve disease – particularly mitral regurgitation and mitral stenosis, which raise pressure in the lungs and strain the right ventricle.
Left heart failure – a weak or stiff left ventricle increases pressure behind it, which is passed to the right side of the heart. See heart failure and diastolic dysfunction.
Pulmonary hypertension – high pressure in the blood vessels of the lungs, from lung disease, sleep apnoea, blood clots in the lungs or other causes.
Atrial fibrillation – long-standing atrial fibrillation enlarges the right atrium and stretches the valve ring, even when the left side of the heart is normal.
Right ventricular disease – for example after a heart attack affecting the right ventricle or in cardiomyopathy.

Causes of primary (organic) tricuspid valve disease

Congenital – Ebstein anomaly and other congenital conditions of the valve
Rheumatic heart disease – the commonest cause of tricuspid stenosis
Endocarditis – infection of the valve, which is more common in people who inject drugs, who have intravenous lines or who have a pacemaker or defibrillator
Pacemaker or defibrillator leads – a lead crossing the valve can interfere with leaflet movement or damage a leaflet
Carcinoid syndrome – a hormone-producing tumour that can thicken and fix the valve leaflets
Chest injury, prolapse and flail leaflets – less commonly
Certain medicines – for example, ergot-derived drugs and some older appetite suppressants have been linked to valve damage

Risk factors

Increasing age, particularly over 70
Female sex
Atrial fibrillation
Left-sided heart disease
Pulmonary hypertension and chronic lung disease
A pacemaker or implantable defibrillator
Previous rheumatic fever
Previous heart surgery on the left-sided valves

Can it be prevented?

There is no way to prevent every case. You can lower your risk by treating high blood pressure, controlling atrial fibrillation, treating sleep apnoea, having left-sided valve disease reviewed and treated at the right time, and seeking early treatment for any heart or lung condition.

When to see a doctor about tricuspid valve disease

Tricuspid valve disease is often silent for many years, so a regular review is important if you have been told you have a leak. See a doctor if you have new symptoms or if your symptoms are getting worse.

Arrange a prompt assessment if you have:

New or increasing swelling of the ankles, legs or abdomen
Unexplained tiredness, loss of appetite or reduced exercise capacity
Breathlessness that is new or worse than before
A heart murmur found by your doctor that has not been investigated
An echocardiogram report mentioning moderate or severe tricuspid regurgitation
Palpitations or an irregular pulse
Weight gain of more than 2 kg over a few days

If your report says mild tricuspid regurgitation and you have no symptoms

This is very common and is usually a normal finding. In most people it needs no treatment and no routine follow-up, unless there is also another heart problem or the right side of the heart looks enlarged. A consultation can help to explain the report and confirm that nothing else needs attention.

Fever and a known valve problem

If you have a known heart valve problem, a prosthetic valve or a pacemaker or defibrillator and develop a fever, sweats or chills that do not settle, or you feel unwell without a clear cause, see a doctor the same day. Infection of the valve (endocarditis) needs urgent assessment and blood cultures before antibiotics are started.

Call 999 immediately if you have:

Severe chest pain or pressure
Sudden severe breathlessness or breathlessness at rest
Fainting or collapse

How tricuspid valve disease is diagnosed

Tricuspid valve disease is diagnosed with a clinical assessment and echocardiography. Further tests may be needed to find the cause and to plan treatment.

1. History and examination

Your cardiologist will ask about symptoms, previous heart and lung disease, rheumatic fever, pacemaker or defibrillator leads, medicines and family history. Examination looks for a murmur, raised neck veins, an enlarged liver, abdominal fluid and swelling of the legs.

2. ECG

An ECG can show atrial fibrillation, enlargement of the right atrium or right ventricle, and conduction problems. It does not diagnose valve disease on its own. See ECG reporting.

3. Blood tests

Blood tests commonly include NT-proBNP (a marker of heart strain), liver function (which can be abnormal when the liver is congested), kidney function, thyroid tests, iron studies and a full blood count.

4. Echocardiogram: the key test

An echocardiogram (heart ultrasound) is the main test. It shows:

The structure of the leaflets and the size of the valve ring
The direction and size of the leak, and measurements of its severity such as the vena contracta width and the effective regurgitant orifice area
Backward flow in the liver veins, which indicates a severe leak
The size and pumping function of the right ventricle and the size of the right atrium
The estimated pressure in the lung circulation
The width and collapsibility of the inferior vena cava, which shows pressure in the veins
Associated left-sided valve disease and left ventricular function

Because the right ventricle has a complex shape, its function is difficult to measure on a standard echo. Three-dimensional echo, strain imaging and additional views can help.

We offer a private echocardiogram in Peterborough, Corby and London.

5. Tests to find the cause and plan treatment

Cardiac MRI – accurate measurement of right ventricular size and function when the echo is unclear.
CT scan – used before transcatheter procedures to measure the valve and plan the approach.
Transoesophageal echocardiogram – a probe passed into the gullet, to see the valve in detail, particularly if endocarditis is suspected or before a procedure.
Right heart catheterisation – measures the pressure in the right heart and lungs directly, when pulmonary hypertension is suspected.
Heart rhythm monitoring – to look for atrial fibrillation. See cardiac monitoring.
Lung and sleep tests – to look for lung disease and sleep apnoea.

How the severity is decided

The grade of tricuspid regurgitation is based on several measurements together, not one number. Your cardiologist will also consider your symptoms, the size and function of the right ventricle, the lung pressures and the state of the left heart. A heart team in a specialist centre usually makes decisions about intervention.

Tricuspid valve disease treatment options

Treatment depends on the cause, the severity, your symptoms and the condition of the right ventricle. Mild tricuspid regurgitation needs no treatment. For moderate and severe disease the aim is to relieve symptoms, treat the underlying cause and, when it is the right option, repair or replace the valve.

Treating the cause

Because most tricuspid regurgitation is secondary, treating the underlying problem is the first step:

Controlling heart rate and rhythm in atrial fibrillation, including cardioversion or ablation where appropriate
Treating left heart failure and high blood pressure
Treating or surgically correcting left-sided valve disease at the right time
Treating pulmonary hypertension and its cause, and treating sleep apnoea or lung disease
Treating infection of the valve with a prolonged course of antibiotics, under specialist care

Medicines

Diuretics (water tablets) such as furosemide or bumetanide reduce fluid retention, swelling and the congestion of the liver and abdomen. Higher doses or a combination of diuretics are sometimes needed.
Mineralocorticoid receptor antagonists such as spironolactone or eplerenone may be added, particularly when there is fluid retention or heart failure.
Medicines for heart failure and atrial fibrillation are used when these conditions are present, including anticoagulation (blood thinners) in atrial fibrillation where indicated.

Medicines relieve fluid retention but do not repair the valve. They should be prescribed and monitored by your doctor, with blood tests to check kidney function and potassium.

Surgery

According to the 2021 ESC/EACTS guidelines, surgery is recommended for:

Severe tricuspid regurgitation (primary or secondary) in patients who are having left-sided valve surgery
Symptomatic severe primary tricuspid regurgitation, if the right ventricle function is not severely reduced

Surgery should also be considered for moderate secondary tricuspid regurgitation at the time of left-sided valve surgery, particularly if the valve ring is dilated, and in selected patients with severe isolated tricuspid regurgitation, where the right ventricle is enlarged but not severely impaired. Repair, using a ring or band to reduce the size of the valve ring, is preferred to replacement when it is possible. Replacement with a tissue (biological) valve is used when repair is not possible.

Surgery on the tricuspid valve alone, after previous left-sided surgery, carries a higher risk, which is why timing and patient selection are important.

Transcatheter (keyhole) treatment

Several procedures are now available for patients with severe tricuspid regurgitation who are too high risk for surgery. They are carried out through a vein, usually in the groin, without opening the chest:

Transcatheter edge-to-edge repair (TEER) – a clip joins the edges of the leaflets to reduce the leak. In the TRILUMINATE Pivotal randomised trial of 350 patients, TEER improved quality of life and reduced the severity of the leak compared with medical therapy alone, but there was no clear difference in death, tricuspid valve surgery or hospital admission with heart failure at one year (Sorajja et al., N Engl J Med 2023).
Transcatheter tricuspid valve replacement – a new valve is placed through a vein. In the TRISCEND II randomised trial of 400 patients, valve replacement plus medical therapy was superior to medical therapy alone on a composite outcome driven mainly by symptoms and quality of life, but severe bleeding and new pacemaker implantation were more common (Hahn et al., N Engl J Med 2025).

These treatments are performed at specialist centres and are available in the UK only in selected cases. Your suitability is assessed by a heart team using echocardiography and CT.

Treating tricuspid stenosis

Tricuspid stenosis is managed with diuretics and, when severe and symptomatic, with surgery. A balloon valvotomy is occasionally used. Tricuspid stenosis is often treated at the same time as the mitral valve.

Following up

You will usually be reviewed with repeat echocardiograms to check the leak, the right ventricle and the lung pressures. The interval depends on severity: mild leaks often need none, while moderate or severe disease may need review every 6 to 12 months or sooner if symptoms change.

Living with tricuspid valve disease

Most people with mild tricuspid regurgitation can live normally. With moderate or severe disease, a few measures help to keep you well and to detect change early.

Day-to-day self-care

Weigh yourself daily, at the same time each morning. A gain of more than 2 kg in 3 days should be reported to your doctor.
Take diuretics as prescribed and know whether you have a flexible dose plan.
Reduce salt in your diet, particularly processed and takeaway foods. Your doctor may advise on fluid intake if you are retaining fluid.
Raise your legs when sitting if your ankles swell, and ask about compression stockings.
Keep a record of symptoms and share it at your reviews.

Exercise

Regular moderate activity, such as walking or cycling, is encouraged. If you have symptoms, ask your cardiologist how much is appropriate, and whether cardiac rehabilitation would help. Stop and seek advice if you have chest pain, faintness or marked breathlessness.

Atrial fibrillation and rhythm

If you have atrial fibrillation, take rate-control medicines and anticoagulants as prescribed. Controlling the rhythm can improve symptoms.

Pacemakers and defibrillators

If you have a device, keep regular device checks. Tricuspid regurgitation can develop or worsen after lead implantation, and your team will watch for this.

Infection and dental care

Good dental hygiene reduces the risk of infection of the heart valves. NICE guidance does not recommend routine antibiotic prophylaxis for dental procedures in people with valve disease, but you should tell your dentist about your valve condition and seek urgent help for an unexplained fever.

Pregnancy

Mild tricuspid regurgitation is not a problem in pregnancy. Severe regurgitation, tricuspid stenosis or a previous valve operation should be discussed with a cardiologist before pregnancy.

Driving and travel

Most people with tricuspid valve disease can drive a car, unless they have symptoms that could affect driving, such as fainting. Check current DVLA guidance if you have a pacemaker, defibrillator or symptoms. Flying is usually safe if you are stable, but discuss long-haul travel with your doctor if you have severe disease or fluid retention.

Follow-up

Attend your scheduled reviews and echocardiograms, and contact your doctor early if symptoms change.

Tricuspid valve disease prognosis and outlook

The outlook depends on the cause, the severity of the leak, the condition of the right ventricle and any other heart or lung disease. It varies widely from person to person.

Mild tricuspid regurgitation

The outlook is excellent. It is a common finding and is not associated with a shorter life expectancy when the heart is otherwise normal.

Moderate and severe tricuspid regurgitation

Significant tricuspid regurgitation is associated with higher mortality and more hospital admissions. In the Minnesota community study, even isolated tricuspid regurgitation, with no other heart disease, was independently associated with higher mortality after adjustment for age, sex, ejection fraction, atrial fibrillation and other illnesses, and only 2.6% of patients with moderate or worse tricuspid regurgitation ever had tricuspid valve surgery (Topilsky et al., JACC Cardiovasc Imaging 2019). This is one reason why tricuspid disease is now taken more seriously and why new treatments have been developed.

What influences the outlook

The severity of the leak and whether it is getting worse
The size and function of the right ventricle
Pressure in the lung circulation
Atrial fibrillation
Kidney and liver function, which can be affected by congestion
Left-sided heart disease and left ventricular function
Your age and other illnesses

Can the leak improve?

Secondary tricuspid regurgitation can improve when the underlying cause is treated, for example after fixing a left-sided valve, restoring a normal heart rhythm or reducing lung pressures. It does not always improve, which is why some patients are reviewed for direct treatment of the tricuspid valve.

After treatment

Outcomes after surgery or transcatheter treatment depend on how early the treatment is given. Treatment before the right ventricle is severely damaged and before there is liver and kidney impairment gives the best chance of benefit.

Tricuspid valve disease key facts

The tricuspid valve lies between the right atrium and right ventricle. Tricuspid regurgitation (a leaking valve) is far commoner than tricuspid stenosis (a narrowed valve)
Mild tricuspid regurgitation is common, often normal, and usually needs no treatment
Most significant tricuspid regurgitation is secondary: the valve is normal but is stretched by an enlarged right heart, usually from left-sided heart disease, pulmonary hypertension or atrial fibrillation
Typical symptoms are swelling of the ankles and abdomen, tiredness and breathlessness, and they develop slowly
The echocardiogram is the key test, with ECG, NT-proBNP and sometimes MRI, CT or catheter studies to find the cause
Treatment starts with the cause and a diuretic for fluid; surgery is recommended for severe leaks at the time of left-sided valve surgery and in selected symptomatic patients
Transcatheter clip repair and valve replacement are newer options for patients at high surgical risk, available at specialist centres
Earlier treatment, before the right ventricle fails, gives the best results
Contact your doctor for new swelling, weight gain or worsening breathlessness; call 999 for severe chest pain, fainting or sudden severe breathlessness

We offer a private echocardiogram in Peterborough, Corby and London.

Guidelines and sources

This page follows current UK and European guidance and the research cited:

NICE NG208: Heart valve disease presenting in adults: investigation and management (2021).
Vahanian A et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. European Heart Journal 2022;43:561-632.
Otto CM et al. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease. Circulation 2021;143:e72-e227.
Topilsky Y et al. Burden of tricuspid regurgitation in patients diagnosed in the community setting. JACC Cardiovasc Imaging 2019;12:433-442.
Prihadi EA et al. Morphologic types of tricuspid regurgitation: characteristics and prognostic implications. JACC Cardiovasc Imaging 2019;12:491-499.
Hahn RT, Zamorano JL. The need for a new tricuspid regurgitation grading scheme. Eur Heart J Cardiovasc Imaging 2017;18:1342-1343.
Sorajja P et al. Transcatheter repair for patients with tricuspid regurgitation (TRILUMINATE Pivotal). N Engl J Med 2023;388:1833-1842.
Hahn RT et al. Transcatheter valve replacement in severe tricuspid regurgitation (TRISCEND II). N Engl J Med 2025;392:115-126.

Tricuspid valve disease questions and answers

What is tricuspid valve disease in simple terms?

It means the valve between the two right-sided chambers of the heart is leaking or narrowed. Most often it leaks, which lets blood flow backwards and can cause swelling of the legs and abdomen and tiredness.

Is mild tricuspid regurgitation serious?

No. Mild tricuspid regurgitation is very common, often a normal finding on echocardiography, and usually needs no treatment or follow-up if the heart is otherwise normal.

What is the difference between tricuspid regurgitation and tricuspid stenosis?

In regurgitation the valve does not close properly and leaks backwards. In stenosis the valve does not open fully and restricts forward flow. Regurgitation is much more common.

What causes tricuspid regurgitation?

Most cases are secondary to enlargement of the right heart from left-sided heart disease, pulmonary hypertension or atrial fibrillation. Less often the valve itself is diseased, for example from infection, rheumatic disease, a congenital abnormality, carcinoid syndrome or pacemaker leads.

What are the symptoms of tricuspid valve disease?

Swelling of the ankles, legs and abdomen, tiredness, reduced exercise capacity, loss of appetite and breathlessness. Many people with mild disease have no symptoms.

How is tricuspid regurgitation diagnosed?

With an examination and an echocardiogram, which shows the valve, the severity of the leak and the size and function of the right ventricle. ECG, blood tests including NT-proBNP and sometimes MRI or CT help to find the cause and plan treatment.

Can tricuspid regurgitation be treated without surgery?

Yes. Treating the underlying cause and using diuretics relieve symptoms in many people. For severe leaks in patients at high surgical risk, a transcatheter clip or valve replacement may be an option at specialist centres.

When is surgery needed for tricuspid regurgitation?

Surgery is recommended for severe tricuspid regurgitation in patients who need left-sided valve surgery, and for symptomatic severe primary tricuspid regurgitation when the right ventricle is not severely weakened. It may also be considered in selected patients with isolated severe disease.

Can tricuspid regurgitation go away?

Secondary tricuspid regurgitation can improve if its cause is treated, for example after mitral valve repair or when a normal heart rhythm is restored. A structurally damaged valve will not heal on its own.

Does tricuspid regurgitation cause a heart murmur?

Yes. It causes a murmur at the lower left edge of the breastbone that is often louder when you breathe in. Not every murmur means valve disease, and an echocardiogram can tell the difference.

Can I exercise with tricuspid regurgitation?

Most people with mild disease can exercise freely. If you have symptoms or severe disease, discuss a safe level of activity with your cardiologist.

What is the life expectancy with tricuspid valve disease?

Mild disease does not shorten life. Moderate to severe tricuspid regurgitation is associated with higher mortality, which depends on the cause, right ventricular function and other illnesses. Early assessment and treatment improve the outlook.

Can I have my echo report explained privately?

Yes. We offer telephone, video and face-to-face consultations to explain your echocardiogram report and plan follow-up, and private echocardiograms in Peterborough, Corby and London.

Questions to ask your cardiologist about tricuspid valve disease

Questions to ask your cardiologist

Bring this list to your appointment. It can help you get the most from your time with your cardiologist. Write down the answers so you can share them with your family.

How severe is my tricuspid regurgitation or stenosis, and which measurements on my echo led to that grade?
Is the valve itself diseased, or is the leak secondary to another problem such as left-sided valve disease, atrial fibrillation or high lung pressure?
Is it causing my symptoms, or could something else explain them?
How well is my right ventricle working, and is the right side of the heart enlarged?
What is causing it, and has the underlying cause been treated?
Do I need further tests, such as NT-proBNP, cardiac MRI, CT, a transoesophageal echo or heart rhythm monitoring?
Would a water tablet help me, and what side effects and blood tests should I expect?
When would surgery or a transcatheter procedure be considered, and would I be suitable?
How often should my echocardiogram be repeated, and what weight gain or symptoms should make me call?
Is there anything that should change my day-to-day life, such as exercise, salt, travel, pregnancy or dental care?

Tricuspid valve disease diagrams and visual aids

What tricuspid regurgitation means

Normal tricuspid valve compared with tricuspid regurgitation: the leaflets do not meet and blood leaks backwards into the right atrium.

Diagram: Dr Salam Salloum, uk-cardiologist.co.uk.

In tricuspid regurgitation the valve between the right atrium and right ventricle does not close properly. Blood flows backwards with each beat, pressure rises in the veins and the right side of the heart enlarges, which is why swelling of the ankles and abdomen is the typical symptom.

From cause to symptoms

Left-sided disease, lung pressure and atrial fibrillation stretch the valve ring; the leak then causes congestion and tiredness.

Diagram: Dr Salam Salloum, uk-cardiologist.co.uk.

Most tricuspid regurgitation is secondary to another problem. Treating the cause, such as atrial fibrillation or left-sided valve disease, can reduce the leak and the symptoms.

Treatment at a glance

The four steps: treat the cause, relieve fluid, surgery and transcatheter treatment.

Diagram: Dr Salam Salloum, uk-cardiologist.co.uk.

Treatment starts with the cause and a water tablet for fluid. Surgery or a transcatheter procedure is considered for severe leaks, in a specialist heart team. Any medicine should be prescribed by your own doctor.

Related guides

Heart Valve Disease

Mitral Valve Regurgitation

Swollen Ankles and Leg Swelling

Book a consultation

If you have been told you have a leaky tricuspid valve, a heart murmur, or an echo report showing tricuspid regurgitation, you may benefit from a telephone consultation or video consultation to have your report explained and your follow-up planned, or a face-to-face consultation in Peterborough or Corby for a more comprehensive assessment.

Investigations such as echocardiography, ECG reporting and cardiac monitoring may be recommended to grade the valve problem and look for the cause.