The Heart's 'Forgotten Valve'

Until recently, patients with tricuspid valve conditions had few treatment options available. Now, minimally invasive procedures can improve the quality of life for patients with tricuspid regurgitation (TR). 

Jeremiah Depta, MD, interventional cardiologist and Medical College of Wisconsin faculty member, highlights two innovative procedures to treat TR. 

Q: What is the tricuspid valve and how does it help heart function? 

Dr. Depta: The tricuspid valve is one of four valves in the heart. It ensures that blood flows forward to the lungs. When the valve doesn’t close properly, blood can flow backward or regurgitate into the right atrium. Over time, this can lead to heart failure or damage to other organs. 

Q: How common are tricuspid valve problems and what are the most frequent issues that affect this valve? 

Dr. Depta: Tricuspid valve disease is one of the most common valve problems in the United States. Approximately 1.6 million¹ Americans have moderate to severe TR. The most common reasons for TR are heart conditions that cause the valve to swell. In some cases, the valve itself doesn’t work because of an infection, trauma or a condition present since birth. 

Q: What symptoms might indicate a tricuspid valve problem? 

Dr. Depta: People may start to feel fatigue, shortness of breath or reduced ability to exercise or do their typical activities. The condition can progress over time, and fluid will build up in the body causing swelling in the legs, ankles and abdomen. It can be insidious because symptoms develop gradually. This is part of the reason why the condition may go unrecognized and why the tricuspid valve is often referred to as “the forgotten valve.” 

Q: How are tricuspid valve conditions diagnosed? 

Dr. Depta: Diagnosis starts with a physical exam. Most people will get an echocardiogram, which is a noninvasive ultrasound test to assess pumping efficiency and blood flow. We may do more advanced imaging, like a transesophageal echocardiogram and CT scan to assess the heart’s structure, valves and blood flow. 

Q: What procedures are available to treat tricuspid valve problems? 

Dr. Depta: For years, the only option was open-heart surgery, but that isn’t suitable for some patients for a variety of reasons. Now, we offer two minimally invasive procedures that are transforming how we treat TR:

• Transcatheter tricuspid edge-to-edge repair (T-TEER), which repairs the tricuspid valve by clipping the valve’s leaflets together. We access the heart through a vein in the leg and guide a catheter to the tricuspid valve to place small clips.
• Transcatheter tricuspid valve replacement (TTVR), which completely replaces the valve with a new valve that’s delivered through a catheter. This procedure is beneficial for patients who wouldn’t qualify for open-heart surgery or T-TEER.

The great thing about being part of an academic health network is that our specialists have advanced training in these groundbreaking technologies, so we can offer more sophisticated options to our patients.

Q: What can patients expect after a tricuspid valve procedure?

Dr. Depta: They may spend a night or two in the hospital. Recovery is fast compared to traditional open-heart surgery. Most patients are back to their normal activities within a week.

Q: What improvements in quality of life can patients typically expect after successful treatment?

Dr. Depta: The improvements can be quite dramatic. Patients often tell us they feel like themselves again. The swelling goes away and they breathe easier. They have more energy to do their activities.

Lifestyle changes also play an important role in managing TR. A low-sodium diet helps reduce fluid retention and swelling in the legs and abdomen. Staying active with gentle, regular exercise and maintaining a healthy weight further support heart function. These daily habits, combined with close follow-up care, help patients preserve the gains achieved through treatment.

Froedtert & MCW heart and vascular experts consider patients’ specific condition, age, general health and preferences when personalizing care. Our goal is always to improve patients' symptoms, protect their heart and enhance their quality of life. Learn more at froedtert.com/heart.

¹National Institutes of Health's National Library of Medicine