The Relationship Between Tricuspid Valve Diseases and Swelling in the Legs

The tricuspid valve is a structure on the right side of the heart that for many years has been referred to as the “forgotten valve”; yet a disorder of this valve can make itself known through swelling seen particularly in the legs and abdomen. In this article I will explain tricuspid valve diseases and their connection with this swelling.

Tricuspid Insufficiency and Right Heart Failure

The tricuspid valve lies between the right atrium and the right ventricle and allows the used blood to move towards the lungs. When this valve cannot close completely (insufficiency), blood leaks back into the right atrium and from there into the body’s veins; the right ventricle is increasingly strained by this extra load and right heart failure may develop over time. The most common cause of tricuspid insufficiency is not the valve itself but the enlargement of the right heart chambers due to left-sided heart or lung disease (functional insufficiency).

Swelling (Oedema) in the Abdomen and Legs as a Symptom

When the right heart cannot pump adequately, the pressure of the blood accumulating in the body’s veins rises; this increase leads to a build-up of fluid in the legs, the ankles and, in advanced cases, in the abdomen (ascites). Our patients often notice this swelling first as their shoes becoming tight or their legs swelling in the evening; as the liver is also affected by this pressure, abdominal bloating and loss of appetite may be added.

Tricuspid Valve Repair

In tricuspid insufficiency too we prefer to repair the valve whenever possible; we generally narrow the widened valve annulus by supporting it with a ring (annuloplasty). If the tricuspid annulus is markedly widened during left-sided valve surgery, we perform the repair in the same session in order to prevent future insufficiency; in symptomatic patients with advanced isolated tricuspid insufficiency, surgical or catheter-based repair options are assessed.

Frequently Asked Questions

Is swelling in my legs always caused by the heart? No; other causes such as kidney disease, liver disease and venous insufficiency can also lead to swelling, so differential diagnosis is important.

Does tricuspid insufficiency resolve on its own? When the underlying cause (for example left-sided valve disease) is treated, mild insufficiency may regress in some patients; advanced insufficiency generally requires a definitive treatment.

When is the tricuspid valve operated on separately? It is assessed separately if the annulus is markedly widened during left-sided valve surgery, or if there is advanced symptomatic insufficiency on its own.

Conclusion

Tricuspid valve diseases are a frequently overlooked cause underlying swelling in the legs and abdomen. With early diagnosis and correct treatment, the progression of right heart failure can be prevented.

If you have unexplained swelling of the legs or abdomen, you can make an appointment for a detailed cardiological assessment.

References

1. Nath J, Foster E, Heidenreich PA. Impact of Tricuspid Regurgitation on Long-Term Survival. J Am Coll Cardiol. 2004;43(3):405-409.
2. Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease. Circulation. 2021;143(5):e72-e227.