Fixing a leaky tricuspid valve

The heart's four valves open and shut in a carefully timed sequence to move blood through and out of the heart to the body. But the leaflets (flaps of tissue that make up the valves) and nearby structures don't always function as they should. Heart valve problems fall into two main categories:

Regurgitation (also known as leakage or insufficiency). The valve leaflets do not close properly, causing blood to flow backward each time the heart contracts.

Stenosis (narrowing). The valve leaflets become thick and stiff, so the valve doesn't open as wide as it should to allow blood to pass through.

Both problems can arise simultaneously in the same valve, and more than one valve may be affected. Malfunctioning heart valves can have serious consequences, potentially hampering the heart's ability to pump sufficient amounts blood throughout the body.

Once referred to as the forgotten valve, the tricuspid valve has been getting more attention of late. Earlier this year, the FDA approved two catheter-based devices for repairing a leaky tricuspid valve (see "Understanding heart valve disease"). Both devices have been shown to relieve symptoms and improve quality of life for people with moderate to severe tricuspid regurgitation, which affects about 4% of people ages 75 and older.

The two valves on the left side of the heart (the aortic and mitral valves) are more likely to develop problems than the tricuspid valve, which separates the upper-right and lower-right chambers of the heart. But that's just one reason that tricuspid valve problems have been underappreciated, says Dr. Pinak B. Shah, executive director of interventional and structural heart services at Harvard-affiliated Brigham and Women's Hospital. "People can have a lot of leakage from the tricuspid valve for a long period of time before they start showing any symptoms," he says.

Causes and symptoms

A range of issues can cause the tricuspid valve to malfunction, including inborn structural problems, heart infections, or conditions (most notably, longstanding atrial fibrillation) that cause the base of the valve to widen. When the valve leaks, blood can flow backward into the right atrium, causing the heart to pump harder. Over time, the heart enlarges and struggles to function normally.

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