The tricuspid valve
The tricuspid valve is one of four heart valves.It is the valve between the right atrium and the right ventricle. Low-oxygen blood flows through it from the body into the right ventricle and is pumped from there into the lungs. The tricuspid valve prevents the blood from flowing back during the pumping process.
The tricuspid valve consists of three leaflets.
Tricuspid valve insufficiency
Tricuspid valve insufficiency is the most common disease of the tricuspid valve. In this case, the valve is leaky so that blood partially flows back towards the body. In most cases, tricuspid valve insufficiency is caused by an enlargement of the right ventricle. This condition often occurs together with or even as a result of mitral valve insufficiency.
If the tricuspid valve is leaking, the blood flows back into the right atrium during the filling and ejection phase of the ventricle and thus into the systemic circulation, where it accumulates. Due to the increasing pressure in the veins, fluid passes through the vessel wall into the surrounding tissue. This leads to water retention.
Accordingly, the following symptoms can occur with tricuspid valve insufficiency:
- Water retention, especially in the legs
- Fatigue and tiredness
- Increase in abdominal girth due to fluid accumulation in the abdomen
- Impairment of liver function due to blood congestion in the liver
Tricuspid valve insufficiency is rarely congenital. It is usually the result of an enlargement or malformation of the right ventricle (Ebstein's anomaly). This can be caused by various diseases, for example pulmonary hypertension or as a result of valve disease in the left heart, such as mitral valve stenosis.
Occasionally, leakage of the tricuspid valve also develops due to an underlying rheumatic disease or bacterial inflammation of the inner lining of the heart (endocarditis).
Research on gender differences
Trikuspidalklappeninsuffizienz zuverlässig erkennen und behandeln
A recent study by DHZC cardiologists Dr. Isabel Mattig (first author) and Prof. Dr. Henryk Dreger (corresponding author) shows that women with heart failure are significantly more likely to have moderate to severe tricuspid valve regurgitation than men. This leakage of the heart valve between the right atrium and the right ventricle worsens the prognosis for patients. The DHZC study demonstrates, for the first time, clear differences between the sexes and the forms of heart failure.
In cases of heart failure, the body is no longer supplied with sufficient blood and oxygen. This can be due either to the heart pumping too weakly or to its inability to fill properly with blood (preserved pumping function). Heart failure with preserved ejection fraction typically occurs more frequently in women, whereas reduced ejection fraction is more common in men.
The study shows: In women, tricuspid valve regurgitation worsens the prognosis particularly when heart failure is accompanied by preserved ejection fraction. In men, on the other hand, tricuspid valve regurgitation is particularly dangerous when heart failure is accompanied by reduced pumping power .
Dr. Isabel Mattig emphasizes: “Women with heart failure and preserved pumping function are a high-risk group in whom tricuspid regurgitation adversely affects health. This makes it all the more important to specifically examine these patients and monitor them closely. Only in this way can tricuspid regurgitation be reliably detected and treated on an individual basis.”
Many symptoms, such as shortness of breath, fatigue, or fluid retention, can be caused by both heart failure itself and an additional valvular disease. Without targeted diagnostic testing, tricuspid regurgitation therefore often goes undetected.
For this reason, an examination of the heart valves using ultrasound (echocardiography) should be an integral part of the evaluation.
If tricuspid valve regurgitation is diagnosed, treatment depends on how severe it is. In some cases, an intervention may be necessary—either minimally invasive via a cardiac catheter or through surgery. It is also particularly important to monitor the condition regularly and closely. This allows changes to be detected early and treatment to be adjusted in a timely manner. This includes:
- Regular appointments at the cardiology outpatient clinic
- Heart checkups at fixed intervals
- Individually tailored treatment plans
At the DHZC, patients with tricuspid valve insufficiency are treated in the “Structural Heart Interventions Program (SHIP)” and are treated in the associated SHIP outpatient clinic. The outpatient clinic serves as the central point of contact for initial consultations, assessment of indications, pre-procedural care, anesthesia counseling, and follow-up care.
Women with heart failure require particularly attentive care. Early diagnosis, regular checkups, and structured follow-up care can play a crucial role in preventing complications and improving quality of life.
“Risks and disease progression differ between women and men. A clear diagnosis and regular checkups for tricuspid valve regurgitation should therefore be more closely tailored to gender,” emphasizes Dr. Isabel Mattig.
The study followed more than 1,000 patients with heart failure for one year. It examined the prevalence of tricuspid regurgitation and its impact on disease progression. 42 percent of women had significant tricuspid regurgitation, compared to 29 percent of men. The study results were published in the BMJ Journal Heart and are available here:
Tricuspid valve stenosis
Tricuspid valve stenosis is an extremely rare heart valve defect in which the opening of the tricuspid valve is narrowed. As a result, venous blood is pumped from the right ventricle into the pulmonary circulation and does not flow back into the right atrium. As tricuspid valve stenosis is usually caused by rheumatic fever, this heart valve diseaseis now rare in countries with good medical care such as Germany.
Patients with tricuspid valve stenosis may also suffer from mitral valve or aortic valve defects.
Diagnosis
- Diseases of the tricuspid valve can be detected with a cardiac ultrasound examination (echocardiography).
- If necessary, our doctors will also carry out an electrocardiogram (ECG) or a chest X-ray.
- If heart valve surgery is necessary, our doctors will also carry out an examination of the coronary vessels to find out whether the heart vessels are affected.
You can find more information on our diagnostics page.
Therapy
In most cases, the defective heart valve can be reconstructed, i.e. repaired, so that it functions perfectly again. This procedure is almost always minimally invasive at the DHZC. The tricuspid valve is operated on via a small incision on the right side of the chest. The heart-lung machine is attached via an access in the groin. In order to have a good view of the valve, a camera is also inserted into the chest cavity. The heart is stopped, then opened and a ring is sutured around the tricuspid valve to stabilise it and reduce its diameter. This allows the valve to close tightly again.
Only in cases of severe tricuspid valve insufficiency or tricuspid valve stenosis must the defective heart valve be replaced with a biological heart valve. These prostheses are made from bovine or porcine tissue. Biological prostheses do not require lifelong blood thinning. However, they may need to be replaced after ten to 15 years.
The Structural Heart Interventions Program (SHIP)
Every year, more than 1,500 interventional heart valve procedures are performed at the Deutsches Herzzentrum der Charité (DHZC). This makes the DHZC a world leader in this field.
Our cardiac surgery and cardiology teams have been working closely together for years in the treatment of heart valve patients. This collaboration will be further expanded and consolidated in the new unit for catheter-based heart valve interventions: The ‘Structural Heart Interventions Programme (SHIP)’ combines the previous cross-hospital units for catheter-based heart valve interventions, i.e. the Transcatheter Valve Unit (TVU) and the Cardiovascular Core Unit (CVCU).
In the ‘Structural Heart Interventions Programme (SHIP)’ unit, we bundle the medical planning and implementation of all catheter-based heart valve treatments in adults. The treatments carried out for heart valve diseases primarily include TAVI procedures to replace the aortic valve, but also catheter-based treatments for diseases of the mitral and tricuspid valves.
All information on the services and the interdisciplinary team of the ‘Structural Heart Interventions Programme (SHIP)’ can be found here.
PD Dr Axel Unbehaun (left) and Prof. Dr Henryk Dreger (right) are the medical directors of the Structural Heart Intervention Programme (SHIP).
In this unit, patients are cared for by an interdisciplinary team - from admission to discharge and aftercare.
PD Dr Axel Unbehaun (left) and Prof. Dr Henryk Dreger (right) are the medical directors of the Structural Heart Intervention Programme (SHIP).
In this unit, patients are cared for by an interdisciplinary team - from admission to discharge and aftercare.
Ebstein anomaly
In patients suffering from Ebstein's anomaly, the tricuspid valve and the right ventricle are malformed. The septal and often also the posterior leaflet of the tricuspid valve are displaced towards the apex of the heart and the valve leaflets are malformed, so that those affected also suffer from tricuspid valve insufficiency. Due to the low position of the valves, the ventricle, which serves the pulmonary circulation, is reduced in size and the atrium is enlarged.
This congenital heart defect occurs very rarely: Ebstein's anomaly accounts for less than one per cent of all congenital heart defects. The exact causes of the disease are still unclear. You can find detailed information on our page about Ebstein's anomaly.
