Tricuspid Valve Replacement Surgery
There are four valves in the heart. These are the tricuspid, pulmonary, mitral, and aortic valves. Each year in the United States surgeons perform nearly 100,000 valve operations. The vast majority of these are to repair or replace mitral or aortic valves. Diseases of the tricuspid and pulmonary valves are less common, but can be just as serious. The tricuspid valve regulates blood flow from the upper right chamber of the heart known as the right atrium to the lower right chamber of the heart known as the right ventricle.
How Is Tricuspid Valve Disease Diagnosed?
Problems with the tricuspid valve are often initially discovered during a physical exam. Frequently an abnormal sound or murmur will be heard. This is caused by abnormal blood flow through the affected valve. There may also be an irregular pulse. Additional testing includes a chest X-ray, electrocardiogram, MRI, or echocardiogram. The results of these tests will determine the extent of the valve disease and whether the patient is a candidate for management with certain medications, valve repair, or valve replacement.
What Diseases Indicate Tricuspid Valve Replacement?
There are two major diseases that affect this valve. Tricuspid regurgitation occurs when the valve allows blood to backflow from the right ventricle back into the right atrium. When this happens blood is forced back into the major veins instead of into the lungs where it normally picks up oxygen. The most common cause of this condition is an enlarged right ventricle; however the tricuspid valve may also become by rheumatic fever. The symptoms of tricuspid regurgitation include weakness, fatigue, swelling of the feet, ankles and stomach, decreased urine output and a yellowing of the skin known as jaundice.
The other common condition affecting this valve is tricuspid stenosis. Stenosis is a narrowing or blocking of the valve. This condition restricts the flow of blood from the right atrium to the right ventricle. The right atrium becomes enlarged while the right ventricle is starved for blood. Stenosis of the tricuspid valve is nearly always associated with rheumatic fever. The symptoms of tricuspid stenosis are often vague and include general fatigue and diffuse pain in the area of the liver.
There are two other forms of tricuspid disease; however these are quite rare. In tricuspid atresia, a congenital heart disease, a wall of tissue blocks blood flow between the heart's right chambers while in Ebstein's anomaly a malformed tricuspid valve sits too low in the right ventricle, allowing blood to leak around it.
What Are My Surgical Options For Tricuspid Valve Replacement?
When replacement is required, the surgeon will use either the traditional or minimally invasive approach depending on the individual circumstances and the results of diagnostic tests. Using the traditional approach the surgeon makes an incision from 6 - 8 inches long at the sternum to gain direct access to the heart. The abnormal valve is replaced and the incision closed.
During minimally invasive surgery, the incision is 3 - 4 inches long and may be either at the sternum or between the ribs. There are several advantages with the less invasive approach. The incision is smaller; there is less bleeding, pain, and surgical trauma, a reduced risk of infection and a shorter hospital stay and recovery time.
The valve may be replaced by either a biological or mechanical valve. There are two types of biological valves including animal tissue that may be either porcine, from a pig or bovine, from a cow or a donated human heart valve called a homograft. With these valves, patients will not need anticoagulants since they are organic tissue. However, these valves may wear out and need to be replaced. Mechanical valves have the advantage of durability; however since they are not made of tissue, blood may stick to them and cause clots. These patients need to remain on anticoagulant therapy. With either valve, tricuspid valve replacement results in prolonged life, reduced symptoms, and an improved quality of life.
Adam Pick is a patient, author of The Patient's Guide To Heart Valve Surgery and the founder of HeartValveSurgery.com.