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Tricuspid Valve – Function, Diseases and Treatment

The tricuspid valve is one of the four heart valves, located between the right atrium and the right ventricle. It ensures a one-directional blood flow through the heart.

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Things worth knowing about "Tricuspid Valve"

The tricuspid valve is one of the four heart valves, located between the right atrium and the right ventricle. It ensures a one-directional blood flow through the heart.

What Is the Tricuspid Valve?

The tricuspid valve (Latin: Valva tricuspidalis) is one of the four valves of the human heart. It is situated between the right atrium and the right ventricle and belongs to the group of atrioventricular valves. Its name reflects its typical structure: the valve consists of three leaflets (cusps) – the anterior, posterior, and septal leaflets. These leaflets are connected to the papillary muscles of the right ventricle via thin fibrous cords called chordae tendineae, which prevent the leaflets from prolapsing into the atrium during ventricular contraction.

Function of the Tricuspid Valve

The primary function of the tricuspid valve is to ensure a unidirectional blood flow from the right atrium into the right ventricle, while preventing backflow (regurgitation) of blood into the atrium during cardiac contraction. During diastole (the relaxation phase), the valve opens to allow oxygen-poor blood to fill the right ventricle. During systole (the contraction phase), the valve closes so that blood is pumped forward into the pulmonary circulation.

Diseases of the Tricuspid Valve

Tricuspid Regurgitation

Tricuspid regurgitation occurs when the valve does not close properly, allowing blood to flow back into the right atrium during systole. This can cause the right atrium to enlarge over time and may contribute to right-sided heart failure. Common causes include dilation of the right ventricle (e.g., due to pulmonary hypertension), rheumatic fever, or infective endocarditis.

Tricuspid Stenosis

Tricuspid stenosis refers to a narrowing of the valve opening, which restricts blood flow from the right atrium into the right ventricle. This condition is less common than regurgitation and is often caused by rheumatic fever or congenital heart defects. Typical symptoms include signs of venous congestion such as jugular vein distension, liver enlargement (hepatomegaly), and peripheral edema.

Congenital Malformations

A notable congenital condition is Ebstein anomaly, in which the tricuspid valve is displaced downward into the right ventricle. This reduces the functional size of the right ventricle and may be associated with additional cardiac defects.

Diagnosis

Tricuspid valve disorders are primarily diagnosed using echocardiography (cardiac ultrasound), which provides detailed imaging of valve structure and function. Additional diagnostic tools include Doppler ultrasound for measuring blood flow velocities, cardiac MRI, and, where necessary, cardiac catheterization.

Treatment

Treatment depends on the type and severity of the valve disorder:

Medical therapy: Diuretics to manage fluid retention, cardiac glycosides, and other heart-supporting medications.
Surgical valve repair: In many cases, the valve can be preserved through annuloplasty (tightening of the valve ring) or leaflet repair.
Valve replacement: If repair is not feasible, the valve is replaced with a mechanical or biological prosthesis.
Catheter-based procedures: Minimally invasive techniques such as Transcatheter Edge-to-Edge Repair (TEER) are increasingly used, particularly in patients with high surgical risk.

Clinical Significance

Tricuspid valve disease has historically been considered less significant than left-sided valve disease. However, recent research demonstrates that tricuspid regurgitation in particular is associated with increased mortality and reduced quality of life. Early diagnosis and timely intervention are therefore of considerable clinical importance.

References

Vahanian, A. et al.: 2021 ESC/EACTS Guidelines for the management of valvular heart disease. European Heart Journal, 2022; 43(7): 561-632.
Nishimura, R.A. et al.: 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease. Journal of the American College of Cardiology, 2014; 63(22): e57-e185.
World Heart Federation: Valvular Heart Disease. Available at: https://world-heart-federation.org (accessed 2024).

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