What is a tricuspid valve?
The tricuspid valve, one of the heart’s four vital valves, plays an important role in making sure blood flows properly from the heart to the rest of the body. The valve is positioned between two of the heart’s four pumping chambers: the right atrium (at the top) and the right ventricle (at the bottom.) It has three leaflets (also known as flaps or cusps) that control blood flow by opening and closing.
What is the tricuspid valve’s role in circulation?
The tricuspid valve controls the flow of oxygen-poor blood between the right atrium to the right ventricle, which pumps blood to the lungs for oxygenation.
What is tricuspid valve disease?
Tricuspid valve disease impedes the circulation process and can cause fatigue, shortness of breath, and potentially heart failure.
Tricuspid valve disease can present in one of three ways:
- Tricuspid atresia, a congenital heart defect (CHD) in which the tricuspid valve and right ventricle are absent
- Tricuspid stenosis, a narrowing of the tricuspid valve, which restricts blood flow
- Tricuspid regurgitation, an incomplete closure of one of the tricuspid valve’s leaflets, allowing blood to flow back into the right atrium
The disease and its presentations can also be associated with:
- Ebstein’s anomaly
- Hypoplastic left heart syndrome (HLHS)
- Endocarditis
- Tetralogy of Fallot (TOF) and pulmonary regurgitation
- Pulmonary atresia
Treating Ebstein’s anomaly and tricuspid valve disease
In Ebstein’s anomaly, the valve’s leaflets are malformed and positioned too low in the right ventricle. Because of this, the condition can enlarge the atrium and lead to congestive heart failure. We turn to one of several repair procedures to treat the condition.
Tricuspid Valve Disease | Diagnosis & Treatments
How we approach treatment for tricuspid valve disease
The Congenital Heart Valve Program at Boston Children’s specializes in the care and treatment of tricuspid valve disease. Our team carefully considers two primary approaches when treating tricuspid valve disease: tricuspid valve repair and tricuspid valve replacement. The approach depends on the individual case, as we consider a patient’s condition, the severity of the disease, their heart anatomy, and overall health.
Using innovative three-dimensional modeling — as well as two- and three-dimensional cardiac echocardiography, CT scans, and cardiac magnetic resonance imaging (MRI) — we can see all aspects of a patient’s tricuspid valve disease and their heart anatomy. The perspectives allow us to determine, before surgery, the proper approach to treatment and how we can preserve native tissue. These imaging techniques are particularly important for treating patients who have Ebstein’s anomaly, as they provide us a detailed roadmap that helps us plan that complex repair.
Tricuspid valve repair or reconstruction
Children benefit when their heart valves can be repaired. We’re constantly creating solutions and techniques to repair tricuspid valves so they can remain structurally intact and keep the other parts of the heart strong and healthy. That includes new reconstruction techniques that can improve the function of diseased tricuspid valves that were once considered untreatable. Here are two surgical approaches we take to repair or reconstruct tricuspid valves:
- Cone procedure: Extra tissues on the enlarged right side of the heart are folded, and the malformed tricuspid valve is surgically reshaped into a cone that opens and closes. We typically use the cone procedure to treat Ebstein’s anomaly.
- Starnes procedure: To improve the health of newborns, the tricuspid valve is patched, taking the underdeveloped right ventricle out of the circulation process. This step shifts the workload to the left ventricle, which should eventually form properly with a larger role in blood flow.
Tricuspid valve replacement
Unfortunately, some children have advanced tricuspid valve disease and repairs aren’t enough. They instead need a replacement valve. This involves removing the damaged tricuspid valve and replacing it with a mechanical or biological valve.
- Bioprosthetic aortic valve replacement: Bioprosthetic tissue that replaces an aortic valve is made from animal tissue (pig or cow). A drawback is the animal tissue might not last long and a patient will eventually need another replacement valve.
- Mechanical aortic valve replacement: Mechanical aortic valves are made of strong, durable materials like metal or carbon. They don’t wear out easily and can last a long time. However, the risk of blood clot formation is high, so a patient will have to take blood thinners over a lifetime.
Also, small prosthetic valves are limited in availability, which means young patients may need more interventions as they grow. We are always trying to extend the life of a replacement tricuspid valve and avoid the disadvantages of bioprosthetic and mechanical valves. That’s why we’re constantly searching for new ways to improve the functionality of replacement valves.
Treatment for tricuspid valve disease gives Alyvia ‘endless energy’
Born without a tricuspid valve, Alyvia had surgery at Boston Children’s and is now enjoying life, while also advocating for heart treatment in her home state of Mississippi.
