Tricuspid regurgitation

[Angie554]

Hi All. My aortic valve was replaced in 2018 and since then I've had an echocardiogram every 2 years. The latest echo suggested i have mild to moderate tricuspid regurgitation.Has anyone had similar and what should I do to slow down any progression to severe? What advice is given by cardiologists?

[PadThaiNoodles]

My valve issues were caused by degenerative valve disease. My cardiologist said there was nothing I could do to change the rate of progression. It took about 10 years to reach severe, but mine was left side (mitral) rather than right (tricuspid).

[Angie554 in reply to PadThaiNoodles]

OK thanks......is there any treatment for your condition?

[PadThaiNoodles in reply to Angie554]

I was never symptomatic, so they waited another 5 years or so until I started to show left ventricular hypertrophy due to the regurgitation. Then I had OHS to repair my mitral valve and replace my aortic valve. (That was about 6 months ago.)

[Angie554 in reply to PadThaiNoodles]

OK thanks....hopefully you're sorted now

[PadThaiNoodles in reply to Angie554]

Yeah, I got a mechanical aortic valve and an angioplasty ring around my repaired mitral valve, so I should be good for the duration.

Good luck with yours!

[RMG48 in reply to PadThaiNoodles]

I had TR mild to severe about 2 or 3 years ago but presently it progressed to severe. I am 76 still able to go for 45 mins walk almost daily and do some light physical exercising. This week I had a TOE test to establish if I am a candidate for a TriClip procedure, the very latest non invasive technology.. Still waiting for reply. Just hope I am a good candidate for such procedure. Anybody went through this procedure?

[PadThaiNoodles in reply to RMG48]

Several people on here have gotten MitraClips, which I imagine are pretty much the same. Might be worth starting a new thread to see if they’re still around….

[Rosie1066]

I had an aortic valve replacement back in 2008 and have recently found, due to an Echo, that I also have mild regurgitation of the tricuspid valve. I’m not sure what can be done. I also have an ascending aortic aneurysm which, luckily has not grown in years, so I’m hoping, like my aneurysm, the tricuspid valve regurgitation not get too moderate/ severe.

[Angie554 in reply to Rosie1066]

From the research I've done mild regurgitation is very common and could be present in 70% of the population!

[Borderterriorist]

I've got moderate regurgitation of the tricuspid valve, back in 2019 it was mild. I have no idea if this is an average progression or not, I'm 76.

[Cat04]

I had AVR two years ago and my echo now shows moderate obstruction of the prothesis with turbulent flow, (patient-prosthetic-mismatch) moderate mitral regurgitation and moderate tricuspid regurgitation. As I say, I used to have one dodgy valve and now I have three! I am awaiting a stress echo and mri to confirm the way ahead.

[Angie554 in reply to Cat04]

Be interesting to know what the plan is when you've had the mri etc

[PadThaiNoodles in reply to Cat04]

Did they give you a myotomy and myectomy when they did the AVR? My surgeon reduced the thickness of the wall between my ventricles to reduce the risk of systolic anterior motion of my repaired mitral valve, but it can also reduce the risk of obstruction of the aortic valve.

I don’t know how common the procedure is (my surgeon is a real belt & braces type guy). But it might be worth asking about if you do need your prosthetic swapped out.

[Cat04 in reply to PadThaiNoodles]

No I didn't have myotomy/myectomy. I have been told by one surgeon I don't need a re-do and that I do by another surgeon! Seems to be a lack of consistence of opinion so I shall await my mri and next echo results and question them again!

[PadThaiNoodles in reply to Cat04]

Ugh. Well, I wish you well with whatever the plan turns out to be.

[Cat04 in reply to PadThaiNoodles]

Thank you 😊

[Anothernewbie]

I don't think there us anything you can do, just sit it out. Strangely enough my experience seems at odds with others on here.

In Sept 21 after a fall, an echo showed I had mild to moderate tricuspid regurgitation.

In June 23 after an A.Fib episode in March 23 it was mild, the cardiologist said it was nothing to worry about and even if it was severe they would not do anything.

In November 24 it did not show up.

I think I did read somewhere that it can regress, but I cannot remember where. The major change is that after the 2023 A.Fib episode I joined Slimming World, lost 2 stone,and changed my eating habits, and have the weight off. whether this has anything to do with it I have absolutely no idea.

[Angie554 in reply to Anothernewbie]

That's interesting. Maybe the original diagnosis of mild to moderate was an exaggeration?.... I've read that interpretation of echos by cardiologists can be subjective

[Anothernewbie in reply to Angie554]

You could be right. I was very surprised though that the last echo didn't show it all. Fingers crossed it was right but.............

[Suebedoo]

Funnily enough I have been diagnosed with the same thing today - my consultant's letter. My letter says that because mine is mild and the PAP (pulmonary artery pressure) is normal, no further action would be required for that. However, I also had supraventricular tachycardia and frequent ectopic activity and he has suggested trying bisoprolol to relieve the symptoms. I don't really want to start medication if I can help it so am going to either make another appointment to see him or speak to my GP.

[Angie554 in reply to Suebedoo]

Good plan

[Suebedoo in reply to Angie554]

I spoke to my GP who agreed that it wasn’t necessary for me to take bisoprolol unless I think the palpitations are getting in the way of my life. Now I know that they aren’t serious and the regurgitation is normal in many adults, I am going to manage the palpitations naturally unless they change.

[Anon2023]

hi. When I had my first mitral valve replacement (for severe mitral regurgitation) they said that I also had mild to moderate triscupid regurgitation which they said they wouldn't touch. When I had my next ohs (4 months later due to endocarditis) they decided to repair the triscupid valve too. I got the impression that they only did it because I was having ohs anyway and that otherwise they were just going to monitor it. At least they are aware of it and can keep an eye on it.

[Angie554 in reply to Anon2023]

That's good that the tricuspid valve was sorted at the same time.....2 open heart surgeries in 4 months though !!!

[Anon2023 in reply to Angie554]

It wasn't planned 😂. I don't think they would have bothered with the tricuspid if they weren't already re-doing the mitral. The surgeon never seemed concerned about the tricuspid.

[nilmonisikdar40]

The tricuspid valve receives the bad blood ( unoxygentaed blood) from the various parts of the body and pumps it to the lungs for oxygenation . By nature of things it is not as imporant as the bicuspid valve which pumps oxygenated blood to various parts of the body. If it is severe it can lead to cogestion of the bad blood and lead to retention of fluid in the lower limbs . Initially it can be treated with diuretics ( water tablets) . If that doesn't work the cardiologist will run several test before operation will be considered. As far the progression of the narrowing of the valve is considered, it cannot be stopped by medication. I hope this small advice will help. Best wishes.

[resistancewasfutile]

Hi,

I've done quite a bit of research into this because my TR had gone from mild to severe but no one was telling me, even though I was symptomatic. International guidelines that the doctor's would use do stipulate that treatment varies depending on patient and symptoms presenting...but this didn't happen for me. Research led me to find out about the myPACE algorithm, a maths equation that can help doctors find the pacemaker base rate to suit a person whose heart has a preserved ejection fraction. The algorithm was first published in 2021 and has made quite a stir in cardiology and its thinking has been incorporated into current guidelines. For some patients, a higher base rate is beneficial and improves quality of life.

I've had to learn about things on my own and demand to take over my treatment plan to improve my heart's condition... it's a work in progress, though I'm hopeful that raising my resting heart rate from the "set and forget" rate of 50bpm to 70 bpm, has improved my TR.

Have a read and talk to your cardiologist.

Personalized Pacing: A New Paradigm for Patients With Diastolic Dysfunction or Heart Failure With Preserved Ejection Fraction - myPACE

"The myPACE algorithm was designed to provide patients with a customized pacemaker backup rate that is within the normal range of adult resting heart rates. Formula: Personalized heart rate [bpm] = (Height [cm] x -0.37) + 135) x √√ (ejection fraction [%]/50)."

acc.org/Latest-in-Cardiolog...

***

2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines

ahajournals.org/doi/10.1161...

[Angie554 in reply to resistancewasfutile]

That's interesting thanks

[Wigg2]

Hi there

I had the same AVR in 2018 but I haven’t had an Echo for several years now as on the last one they said I didn’t need too because mild regurgitation is normal but is that right ?

And I should be demanding a regular Echo ie every 2 years or so ?

[Angie554 in reply to Wigg2]

Mild regurgitation is normal I believe. I guess the regularity of echos will depend on your own clinical need? I usually have to remind my hospital when it's overdue!

[Wigg2 in reply to Angie554]

Thanks for that