Untreated tricuspid regurgitation: What complications may develop?

Bilge Türk | MediCenter TV

ANKARA, TÜRKİYE — When severe tricuspid regurgitation is left untreated, it can impair right-sided heart function and eventually cause leg swelling, abdominal fluid accumulation, and problems affecting the liver and kidneys.

The condition may progress without producing noticeable symptoms during its early stages, potentially delaying diagnosis. As the valve leakage becomes more severe, patients may develop shortness of breath, fatigue, reduced exercise capacity, swelling in the legs and fluid accumulation in the abdomen.

Cardiologist Professor Kadriye Kılıçkesmez says tricuspid regurgitation is an important heart valve disorder that should not be underestimated. She emphasises that early assessment and appropriate treatment timing are particularly important in patients with severe valve dysfunction.

The condition does not progress at the same rate in every patient. Its course depends on the severity of the leakage, the function of the right side of the heart and the presence of other heart diseases. Treatment decisions therefore need to consider the patient’s symptoms and the effects of the condition on the heart.

How does valve leakage affect the right side of the heart?

The tricuspid valve is located between the right atrium and right ventricle. A healthy valve allows blood to move in one direction from the right atrium into the right ventricle.

When the valve does not close sufficiently, some blood flows backwards into the right atrium as the right ventricle contracts. Mild leakage may remain without noticeable effects for a considerable period. Severe leakage, however, can increase the volume load on both the right atrium and right ventricle.

The right side of the heart may have to work harder to maintain circulation. If this additional workload continues for a long time, the right atrium and right ventricle may enlarge. As the condition progresses, the ability of the right ventricle to contract effectively may also deteriorate.

These changes do not develop at the same speed in every patient. In some people, valve leakage remains limited for a long period. In others, particularly those with accompanying heart disease, the condition may progress more rapidly.

Regular cardiological monitoring is therefore important even when a patient does not have prominent symptoms. Follow-up makes it possible to assess the degree of leakage, the patient’s symptoms and the function of the right side of the heart together.

Symptoms may gradually restrict daily activities

Tricuspid regurgitation can progress silently during its early stages. Some patients may not experience symptoms that interfere with daily life until the condition becomes more advanced.

As the leakage increases and the workload on the right side of the heart becomes more pronounced, patients may experience shortness of breath, fatigue and reduced exercise capacity. Walking or completing routine tasks that were previously manageable may gradually become more difficult.

Swelling in the legs and ankles can be a visible sign of fluid accumulation. In advanced stages, fluid may also collect in the abdomen, increasing discomfort and making movement more difficult.

Weakness and reduced physical capacity can limit a patient’s ability to move independently or carry out everyday responsibilities. When the disease becomes advanced, quality of life may be significantly affected.

The severity of symptoms does not necessarily progress in the same way in every patient. Complaints should therefore be evaluated alongside the degree of valve leakage and the functional condition of the right side of the heart.

Right-sided heart failure may develop without treatment

One of the important consequences of severe tricuspid regurgitation is right-sided heart failure. When the right ventricle can no longer adequately support circulation, blood may accumulate in the venous system.

An increase in venous pressure can cause swelling in the legs and fluid accumulation in different parts of the body. Fluid collecting in the abdominal cavity may also occur as right-sided heart failure progresses.

Reduced right-heart function does not only lead to fluid retention. Patients may also develop fatigue, weakness and a decline in physical capacity. In advanced stages, ordinary daily activities can become significantly restricted.

Long-standing valve leakage may lead to progressive enlargement and impaired contraction of the right side of the heart. When these structural and functional changes become advanced, treatment may become more complicated.

For this reason, waiting until severe symptoms appear may not be an appropriate approach. Regular follow-up allows the medical team to assess valve leakage, symptoms and right-heart function before the condition causes more extensive problems.

Liver and kidney function may also be affected

Tricuspid regurgitation is not limited to the heart. If severe valve leakage leads to right-sided heart failure, increased venous pressure can begin to affect other organs.

Blood may accumulate in the liver, potentially causing liver enlargement. If this congestion continues over a prolonged period, liver function may deteriorate.

Blood flow to the kidneys and the body’s ability to maintain fluid balance can also be affected. Impaired kidney function may make it more difficult to control fluid retention.

Increasing fluid accumulation can worsen swelling in the legs and abdominal distension. Heart failure and declining organ function may then create a cycle in which each problem makes the other more difficult to manage.

Patients with severe tricuspid regurgitation therefore require an assessment that extends beyond the valve itself. Changes in the right side of the heart need to be considered together with liver and kidney function.

Treatment depends on the severity of the condition

A treatment plan is developed according to the degree of valve leakage, the patient’s symptoms, right-heart function and the anatomical characteristics of the valve.

Regular cardiological monitoring may be sufficient for patients with mild leakage who do not have noticeable symptoms. During follow-up, doctors assess whether the condition is progressing and whether new symptoms have appeared.

Diuretic medicines may be used to help control fluid accumulation. Treatment may also be given for accompanying conditions that contribute to the patient’s overall heart problems.

Surgical valve repair or valve replacement may be considered for suitable patients with severe tricuspid regurgitation. For selected patients whose surgical risk is considered high, catheter-based approaches such as TriClip may be evaluated.

The same treatment cannot be applied to every patient. Valve anatomy, the condition of the right side of the heart, the severity of symptoms and the patient’s general health all influence the choice of treatment.

The primary objectives are to reduce symptoms, preserve right-heart function and attempt to prevent complications associated with the progression of the disease.

Why is the timing of treatment important?

As tricuspid regurgitation progresses, the right side of the heart may enlarge and lose some of its ability to contract. If impaired liver or kidney function is added to these cardiac changes, the patient’s overall condition can become increasingly complex.

Treatment decisions should therefore consider not only current symptoms but also the effects of the disease on the heart and other organs. Waiting until symptoms become severe or organ function deteriorates considerably may make intervention more difficult.

Professor Kılıçkesmez draws attention to the importance of early assessment, particularly in patients with severe valve dysfunction. Regular monitoring and planning the necessary intervention at an appropriate time may help reduce the risk of heart and organ damage that could be difficult to reverse.

Patients with tricuspid regurgitation should not interrupt their scheduled follow-up. Cardiological assessment is important when symptoms such as shortness of breath, rapid fatigue, swelling in the legs or abdominal fluid accumulation appear.

Although not every case progresses at the same rate, monitoring the degree of leakage, right-heart function and related organ effects can help determine the most appropriate treatment approach for each patient.

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