The heart has four valves, including the tricuspid valve, which separates the upper and lower chambers on the right side of the heart. If the valve doesn’t close properly, blood can leak backward. If it doesn’t open fully, blood may have difficulty flowing forward.

Where is the tricuspid valve?

The tricuspid valve is located on the right side of the heart, directly between the upper right chamber (right atrium) and the lower right chamber (right ventricle). 

What does the tricuspid valve do?

Blood returning from the body enters the heart’s upper right chamber, called the right atrium. From there, it passes through the tricuspid valve into the right ventricle, which pumps the blood to the lungs to receive oxygen. The tricuspid valve has thin flaps that open to let blood flow forward and close to prevent it from leaking backward.

Symptoms of Tricuspid Valve Disease

Two main problems can affect the tricuspid valve. The more common occurs when the valve’s flaps don’t close tightly, allowing blood to leak backward with each heartbeat. This is called tricuspid regurgitation, or a leaky valve. Less commonly, the valve can become stiff and narrow, making it difficult to open fully. This is called tricuspid stenosis.

Symptoms of a problem with the tricuspid valve include:

• Swelling in the legs, ankles or abdomen
• Feeling full after eating very little
• Fatigue that rest doesn’t fix
• Weight climbing from fluid
• Pulsing or fullness in the neck
• Water pills that stopped working
• Shortness of breath

Call 911 or go to an emergency room if you have heart symptoms such as chest pains, dizziness, shortness of breath or sudden numbness. Get help immediately.

Tricuspid Valve Disease Diagnosis

The most common tests performed to assess a potential tricuspid valve leak and the need for valve repair or replacement include:

• An ultrasound of the heart through the chest wall, and usually a second one through the esophagus (a TEE) while sedated, which gives a much clearer view of the flaps and the gap between them.
• CT scan of the heart. Measures the valve and maps leg veins.
• Right heart catheterization. A thin tube through a vein measures pressure in the lung arteries.
• Blood work and, in some cases, liver imaging, to check for back pressure marks.
• A walking test or frailty assessment to gauge how much of the patient’s limitation comes from the valve.

Questions to Ask the Care Team

• How severe is my leak, and how much of the way I feel is caused by it?
• Is my right ventricle strong enough that fixing the valve will help?
• Am I a candidate for a catheter procedure, or is surgery the better option for my anatomy?
• What are the chances I will need a pacemaker afterward?
• Will I need a blood thinner, and if so, for how long?
• What happens if I choose to wait and manage with medication?
• How many tricuspid procedures does this team do each year?

Words You’ll Hear at the Appointment

• Regurgitation — a valve that leaks backward.
• Annulus — the ring of tissue the valve flaps attach to.
• Leaflet — one of the valve’s three flaps.
• Transcatheter — done through a thin tube in a blood vessel rather than through an incision in the chest.
• TEE — an ultrasound of the heart taken from the esophagus.

Treatment Options for Tricuspid Valve Disease

Tricuspid leaks can develop for many reasons, so treatment often begins by addressing the underlying cause of the leak. This may include:

• Diuretics (water pills) to reduce excess fluid and swelling.
• Heart rhythm treatment to help manage abnormal rhythms that may contribute to enlargement of the right atrium.
• Treatment of other heart valve problems, including disease affecting valves on the left side of the heart.

A procedure to repair or replace the tricuspid valve may be recommended when the leak is severe, symptoms continue despite treatment, and the right ventricle and liver are still healthy enough to recover.

Catheter Repair or Replacement for Tricuspid Valve

Clip repair through a catheter (transcatheter edge-to-edge repair using the TriClip)

During a transcatheter tricuspid valve repair, a catheter is guided through a vein to the heart. One or more small clips are then attached to the valve leaflets, bringing them closer together to reduce the amount of blood leaking backward. This procedure is usually performed by a structural cardiologist.

The procedure does not require a chest incision or the use of a heart-lung machine. Patients receive anesthesia while the care team uses ultrasound and fluoroscopy, a type of X-ray imaging, to guide the procedure.

Clip repair may be an option for patients whose valve leaflets are positioned close enough together for the clips to securely grasp them. Clinical trials have shown improvements in valve leakage, swelling and quality of life following the procedure.

Valve replacement through a catheter (transcatheter tricuspid valve replacement using Edwards Evoque)

Depending on the anatomy and your individual characteristics, we may choose to perform transcatheter tricuspid valve replacement instead of a tricuspid valve repair. During this procedure, a new valve is delivered to the heart through a vein using a catheter. The replacement valve is compressed inside the catheter, positioned within the existing tricuspid valve and then expanded to take over its function.

Your original valve remains in place, with its leaflets held open behind the new valve.

Valve replacement can provide a more complete reduction in leakage than clip repair. However, a patient’s anatomy, overall health and other clinical factors help determine whether this approach is appropriate. The multidisciplinary heart team carefully evaluates these factors and discusses the potential benefits and risks with each patient.

Surgical Repair or Replacement for Tricuspid Valve

Surgical Tricuspid Valve Repair

During surgical tricuspid valve repair, the surgeon reshapes the patient’s existing valve to help it function properly. Most often, a supportive ring is placed around the annulus, the structure that supports the valve leaflets, to restore its size and shape. Depending on the condition of the valve, the leaflets may also be repaired, reshaped or separated if they have become fused.

For patients with Ebstein anomaly, a technique called cone reconstruction may be used to rebuild the valve leaflets using the patient’s own tissue and restore valve function.

Whenever possible, surgical repair is preferred because it allows the patient to keep their natural valve. Repair is often considered when a patient is already undergoing heart surgery for another condition, such as:

• Mitral valve surgery
• Aortic valve surgery
• Coronary artery bypass grafting

In these cases, the tricuspid valve may be repaired during the same operation.

Surgical Replacement for Tricuspid Valve

When the tricuspid valve cannot be repaired, the surgeon may remove the damaged valve and replace it with a new one. In most cases, a biological tissue valve, typically made from cow or pig tissue, is used. Tissue valves are generally preferred in the tricuspid position because mechanical valves have a greater risk of developing blood clots and require lifelong treatment with the blood thinner warfarin.

Tissue valves can wear out over time. If that happens, some patients may be candidates for a valve-in-valve procedure, in which a new valve is placed inside the existing tissue valve using a catheter. This minimally invasive approach may allow eligible patients to avoid another open-heart operation.

Risks

As with any surgery, there are potential risks to consider. These risks can vary depending on the procedure and your overall health. Your care team will work closely with you to explain the risks and help you make an informed decision about your care.

Recovery and Follow-Up

Recovery after tricuspid valve treatment varies from patient to patient and often depends on overall health and physical condition before the procedure.

After a transcatheter procedure, many patients are able to return to light activities relatively quickly. Patients should follow their care team’s recommendations regarding lifting, exercise and other physical activity.

Recovery after open-heart surgery typically takes longer because the breastbone needs time to heal. The surgical team will provide specific guidance about when it is safe to resume activities such as lifting, pushing, pulling and driving.

Managing Swelling

Although valve function may improve immediately after treatment, swelling in the legs or abdomen can take longer to resolve as the body gradually eliminates excess fluid. During recovery, diuretic medications may need to be adjusted.

Patients may be asked to monitor their weight daily to help identify changes in fluid retention.

Significant or sudden changes in weight, swelling or symptoms should be discussed with the care team.

Ongoing Care

Regular follow-up is an important part of recovery. Patients may undergo an echocardiogram and other evaluations to monitor heart and valve function.

Patients should also:

• Inform dentists and other healthcare providers that they have a heart valve device or replacement valve.
• Ask their cardiology team whether antibiotics are needed before certain dental procedures.
• Participate in cardiac rehabilitation when recommended, particularly after surgery or a prolonged period of limited physical activity.
• Take blood-thinning medications exactly as prescribed. These medications should not be stopped or changed without first consulting the prescribing care team, even before a minor medical or dental procedure.

Medically reviewed by Faisal Rahman, B.M.,B.Ch., F.A.C.C., F.S.C.A.I., October 15, 2026