Tricuspid Regurgitation

The tricuspid valve lies between the right atrium and the right ventricle and keeps blood flowing in the correct direction. When this valve becomes leaky (tricuspid regurgitation), blood flows backwards, and over time this increases the load on the right side of the heart. Severe tricuspid regurgitation may cause complaints such as:

• Shortness of breath
• Easy fatigue
• Swelling of the legs
• Fluid accumulation in the abdomen (ascites)
• Palpitations
• Marked limitation of daily activities

Although the treatment options available to these patients remained limited for many years, it is now possible to reduce the regurgitation with non-surgical techniques.

How Is the Diagnosis Made?

Tricuspid regurgitation can now be diagnosed readily with echocardiography, a highly advanced form of cardiac ultrasound. The diagnosis is first established by transthoracic echocardiography (TTE), which requires no more than placing an ultrasound probe on the anterior chest wall. The severity and cause of the regurgitation, the structure of the valve and its suitability for treatment are then assessed in detail by transesophageal echocardiography (TEE), in which a probe is passed through the mouth and positioned in the esophagus. Alongside two-dimensional TEE, three-dimensional echocardiography allows the valve structure to be visualized more clearly. In our clinic, TTE together with two-dimensional and three-dimensional TEE is performed in every patient in whom tricuspid regurgitation is suspected.

Transcatheter Treatment (Tricuspid Valve Clipping): For Whom and How Is It Performed?

Tricuspid TEER (transcatheter edge-to-edge repair) is a transcatheter — that is, non-surgical — treatment developed to reduce tricuspid regurgitation, and it is carried out through the groin. A dedicated clip system is used to bring the valve leaflets closer together so that the valve closes more effectively, and the volume of blood flowing backwards is thereby reduced.

How Is the Procedure Performed?

• The procedure is performed in the angiography laboratory.
• Access is obtained through the femoral vein with fine catheters.
• The catheters are advanced to the right side of the heart.
• Under echocardiographic and fluoroscopic guidance, the clip system is positioned on the tricuspid valve.
• The valve leaflets are secured to one another and the regurgitation is reduced.
• Where necessary, more than one clip may be used.

After the procedure, patients are usually discharged within a few days.

In Which Patients Is It Performed?

TriClip treatment is performed in particular in patients who:

• have severe or very severe tricuspid valve regurgitation;
• have shortness of breath, edema and symptoms of heart failure;
• remain symptomatic despite medical therapy;
• are at high risk for open-heart surgery; and
• are considered suitable by the Heart Team.

What Are the Advantages of the Treatment?

• It is performed without opening the chest.
• It carries a lower risk than open-heart surgery.
• The hospital stay is shorter.
• It may reduce symptoms such as shortness of breath and swelling of the body.
• It may improve quality of life.
• It may reduce hospital admissions due to heart failure.

Today, TriClip treatment has become one of the most important interventional treatment options used to reduce tricuspid valve regurgitation in suitable patients.