Tricuspid Valve – Repair, Replacement, Surgery

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tricuspid-valveTricuspid valve, which is also know as the atrioventricular valve, is located on the right side of the heart. It lies between the right atrium and the right ventricle and governs the flow of blood between these two quadrants. Most commonly the tricuspid valve consists of three leaflets, although some consist of two or four leaflets. The amount of leaflets the tricuspid valve has are also subject to change during one’s life time. In a properly functioning tricuspid valve, pressure builds in the right atrium, causing the tricuspid valve to open up and allows blood to flow into the right ventricle. When pressure in the right atrium decreases (pressure increasing in the right ventricle), the tricuspid valve closes, preventing blood from flowing back into the right atrium.

Tricuspid Valve Disorder

Tricuspid valve disorders are rare and most often occur with other heart valve problems, particularly with the mitral valve. All types of tricuspid valve disease occur when the tricuspid valve narrows, causing an increase of pressure in the right atrium, and decreasing the overall efficiency of the heart. If the tricuspid valve does not close properly, this can result in tricuspid valve leakage in which blood flows back into the right atrium.

Tricuspid Valve Disease

Tricuspid valve disease can be caused by rheumatic heart disease, which is an infection that proceeds strep throat if not treated in a proper manner. This is uncommon in people living in countries with access to modern health care’s medicine and technologies. Occasionally, tricuspid valve disease can be attributed to a congenital condition (passed down through family genes).

Tricuspid Valve Stenosis Symptoms

tricuspid-valve-stenosisSymptoms of the tricuspid valve disease known as tricuspid valve stenosis may not occur for years in a person developing the disease. When symptoms start to occur, they often include an uncomfortable sensation in the neck or chest, due to irregular heart rhythms. Tricuspid valve stenosis can also produce symptoms of right-sided heart failure. These include discomfort of the upper abdomen, resulting because of swelling of the heart and liver.

Tricuspid valve disease can show certain signs that a doctor should be able to recognize upon a routine check up. When a tricuspid valve disorder is present, the heart may produce murmurs that can be heard by use of a stethoscope. In addition to this, there may be an abnormal pulse in the jugular vein located in the neck. Once a doctor suspects a tricuspid valve disease may be present, x-rays and echocardiograms (ultrasound study of the heart) can be used to reach a diagnosis.

tricuspid-valve-repairTricuspid Valve Surgery

If the damage to tricuspid valve is mild, doctors are likely to be able to treat it with medicine. In severe cases of tricuspid valve stenosis, tricuspid valve surgery may be necessary. Tricuspid valve surgeryis typically performed when the condition poses a threat to a person’s life. This means that a person can develop a high risk of heart attack and stroke due to tricuspid valve stenosis. This involves either tricuspid valve replacement or tricuspid valve repair.

Tricuspid Valve Repair

The procedure for tricuspid valve repair is usually performed to treat congenital defects, and usually not those who have developed tricuspid valve stenosis through wear and tear of the tricuspid valve. There are six main actions a surgeon may take to repair a tricuspid valve. These include:
Commissurotomy – Used for narrowed tricuspid valves, where the leaflets are then too large in comparison to the valve. The surgeon opens up the tricuspid valve by cutting away the excess of the leaflets.
Valvuloplasty – Performed when the leaflets of the tricuspid valve are weak. A ring-like device is inserted to the outside of the valve opening, allowing the valve to close and preventing tricuspid valve leakage.
Reshaping – The surgeon cuts a section of the leaflet, and sews it back where necessary in order to reshape the tricuspid valve and allowing it to function properly
Decalcification – The removal of calcium buildup from the leaflets. This allows the leaflets on the valve to close and prevent having a leaky tricuspid valve.
Repair of structural support – Either shortening or replacing the cords that give the tricuspid valve support. When the cords that attach to the tricuspid valve leaflets are the right length, the valve can close and prevent tricuspid valve leakage.
Patching – The surgeon covers holes and/or tears in the leaflets by use of patches made of tissue.

Tricuspid Valve Replacement

Tricuspid valve replacement
is performed when a patient suffers from a life-threatening case of tricuspid valve stenosis and cannot be fixed by a tricuspid valve repair. There are two types of replacement methods used to treat severe tricuspid valve stenosis: one using mechanical tricuspid valve replacement, the other using biological tricuspid valve replacement. Both types of tricuspid valve replacement have their advantages and disadvantages, and it’s best discussed with a doctor which procedure better suits his or her patient.

Mechanical tricuspid valve replacements are generally used with materials suchtricuspid-valve-replacement-mechanical as plastic, carbon, or metal. The mechanical tricuspid valve replacement is much stronger than the biological one, and these usually last indefinitely. However, patients are required to take anticoagulants (blood thinning medication) because blood tends to clot on the mechanical tricuspid valve parts. Blood clotting on the mechanical tricuspid valve can lead to heart attack and stroke, so anticoagulants are a must.

Biological tricuspid valve replacements on the other hand are made from either animal or human tissue. They are not as strong as mechanical tricuspid valve replacements, and need to be replaced about every 10 years or so (they break down even quicker in younger patients). The main advantage of having a biological tricuspid valve replacement is that patients typically do not require to take anticoagulants.

Tricuspid Valve Post-surgery Precautions

Before going in for tricuspid valve surgery, patients are carefully monitored to see if there are any changes in their health. Patients are advised to tell their doctor which (if any) medications they are taking. Even having a common cold should be reported to your doctor, as it can lead to infections during surgery and hinder post-surgery recovery.

Most patients that go in for tricuspid valve surgery spend a few days in ICU (intensive care unit). Joining a cardiac rehabilitation program is also recommended to be sure a patient makes a full recovery. The majority of patients should expect to return to work in 4-6 weeks, but are advised against highly strenuous physical activity such as weight lifting or sprinting.

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