View Full Version : Leaking Tricuspid Valve
August 22nd, 2006, 01:34 PM
Ok ya all. I just got home from my 4 month check up, and the cardio said that my tricuspid valve is leaking pretty significantly...more than my mitral (which is mechanical) and my aortic valves. This showed up on my last echo. Anyway, he said there's not much they can do other than keep me on my mega doses of diuretics. I know nothing about the tricuspid valve, so I'm going to do a google search. They are still watching my mildly stenotic aortic valve and will do another echo in nine months. He said that doing a third OHS to replace the aortic valve is something he doesn't want to think about. Me either. Duh! Any thoughts or advice? LINDA
August 22nd, 2006, 01:53 PM
Dear Twinmaker! (gotta love the name!!)
My husband has a similar situation. He has mechanical mitral and aortic valves, implanted in 2001. He has a severely leaking tricuspid valve, which showed itself about 4-6 months post surgery. He also takes a lot of diuretics.
He has been managed with medication for four and a half years. Unfortunately, he also has chronic atrial fibrillation, and without going into the entire story, he needs a pacemaker. His cardio and the electrophysciologist believe tht he should have a standard implant, which means that the pacing wires would have to cross the tricuspid valve. No can do, unless the tricuspid valve is repaired.
He was originally scheduled to have this surgery (annuloplasty, and then pacemaker) done this month (August). But for reasons I won't go in to now, we are postponing for a bit. (death in the family)
Were it not for the need of the pacemaker, I think the tricuspid repair could have waited quite a bit longer.
The right side of the heart is of course, the passive side, and it takes a long time before it's deficincies create a problem with the left side again. Soooo.....you are not alone in this issue. Take a deep breath. I am sure it came as a surprise to you (as it did to us), but it is definitely not as serious as the mitral/aortic valve situation. By the way, are your issues rheumatic in origin?
August 22nd, 2006, 02:13 PM
Joe also has a signifiacntly leaking tricuspid, and no one wants to touch it. He's already had three valve surgeries. He does have a pacemaker lead going through the valve. He has a very difficult time with fluid retention. And he is being managed with diuretics gingerly, since he also has kidney failure. Not a nice combo of things to have.
August 22nd, 2006, 02:16 PM
I don't have any advice and I'm sorry to hear about the "leakage" but I'm glad that you started this post because I'm kinda in the same situation.My tricuspid valve regurgitation is currently classified as "Moderate". Prior to surgery I asked the surgeon about replacing all three valves and he told me that after replacing the two (mitral,aortic) that the tricuspid would correct itself. :confused: I'm not sure what to expect in the way of symptoms or what havoc a regugitant tricuspid valve will reek on the heart's chambers . Most of the time I feel pretty darn good so I try not to think about it.;)
Therefore I will be watching for some "thoughts and advice" from other folks that may know more.
August 22nd, 2006, 02:41 PM
I have Ebsteins Anomoly which is defective leaflets and downward displacement of the Tricuspid valve. It's a little different than your problem since this is my only problem. My Tricusid leakage in the past has no put any pressure or done any damage to other valves. However, it can create for an enlarged Right Ventricle, which in time will weaken the tissue wall. My Right Ventricle was 4 times larger than a normal sized Ventricle (I don't have the numbers). The heart can adjust for so long before it does causes permanent damage. My feeling is that you can wait a little longer with a Tricupsid leakage but not forever. I don't care to comment on how long. My Tricupsid repair lasted 22 years but god only knows at what point it started to leak severly. I didn't go to my annual check ups like I was supposed too. The Cards breathed a sigh of relief when they said that they had caught it just in time before it did cause permanent damage to my Right Vetricle and enlargement to my liver. The long term effect if left untreated, in my case, was that I could have had heart or liver failure.
August 22nd, 2006, 03:30 PM
I don't like your doctor's 25th anniversary present. Can you return it?:mad:
Sorry to hear of your news. Here's hoping that there's an easily managed solution for a while.
August 22nd, 2006, 03:31 PM
my dad had avr about 6-7 years ago and has a st. jude's mechanical. he is in chronic afib and takes coumadin.
recently his mitral and tricuspid have been found to be leaking significantly and he is going in for minimally invasive surgery in nyc with dr. colvin in the next month (no set date) to have both repaired using the port method (minimally invasive).
i am concerned that he may have coronary artery disease (he already had double bypass at the time of the avr) . the surgeon and cardio who works with him (not my dad's regular cardio) want him to go into the hospital, they can lovenox or heparin-ize him, do the cath one day and surgery the next.
i understand they don't want to bridge twice (once for the cath a few weeks before and then for the actual surgery), but i am concerned that they may find blocked arteries, in which case he is no longer a candidate for the minimally invasive surgery.
i can see their point, but he might want to use his first surgeon if he needs to be opened up from the chest again (at a local_ st. francis heart hospital_ reputable hospital) instead of having dr. colvin do it (he specializes in the minimally invasive surgery and repair of the valves).
guess it's finally hitting me and i'm getting a bit anxious about the whole thing...
linda, my point is that the valve can be repaired/replaced using minimally invasive method, incase you're interested.
take care and be well,
August 22nd, 2006, 03:45 PM
Thanks for your responses. Marybeth, my mitral valve problem stems from Rheumatic Fever, which by the way, I never knew I had. The docs said it was probably a "mild" case, but even mild cases can wreck havoc. It's interesting to hear some of you all talk about pacemaker wires. I have a pacemaker/defibrillator. The first pacer was put in about three to four years ago. The wires were changed about two years ago when I went with the pacer/defibrillator combo. Do the wires always go through the tricuspid valve? My doctor in Tampa had started mentioning the aortic valve becoming stenotic, but never mentioned the tricuspid leaking. Today was the first time I've heard about it. The doc was very emphatic(sp) about it leaking more than the other two. After doing my google search, I saw a lot about heart failure. I've been dealing with a cough for the last several months, and now I'm wondering if it has anything to do with extra fluid.:confused: I feel like my diuretics are working. I tend to lose 3-4 pounds each night, but my weight stays steady each morning taking into consideration the weight loss. I guess what I'm saying is that I gain water weight each day, but also lose it after taking my diuretics. I take Lasix and Aldactone. The doc also did some blood work today which included a blood test for liver function. I guess the liver can be affected by all this?:confused: Oh well, I'm trying not to get too excited or stressed by this news. Any thoughts from you all about the cough would be appreciated. I just didn't put it together with what I heard today until I got in the car and started thinking about it. LINDA
August 22nd, 2006, 03:48 PM
And Karlynn, you're right. This is a pretty sucky gift!:( LINDA
Peggy in Alaska
August 22nd, 2006, 04:29 PM
I have the Ebstein's thing, too, but wasn't properly diagnosed till early 40s. I have heard that they prefer tissue valves as replacements in the tricuspid spot because of clotting issues with a mechanical in that location - something to do with the fact that the tricuspid does not work or pump as hard as other valves?
I think I have heard you can wait longer on the tricuspid, too, as Mike said.
And, Sylvia, I did not know they could do the tricuspid with a miniamally inasive procedure - maybe a repair, but not a replacement - maybe that is the difference. When it comes time for me to have surgery, I have been told, repair is not an option, it will have to be replaced.
August 22nd, 2006, 04:46 PM
I think the cough is from the fluid retention. I have significant problems with fluid retention as a result of pericardial constriction (and my tricuspid is leaking) and when it's out of control, I have the nagging cough. I know Ross has said he does too. Mine disappears when I get the fluid off.
August 22nd, 2006, 04:52 PM
I too, have had AVR/MVR and tricuspid annuloplasty in 2002. They said after surgery they didn't know how well the repair would hold. Six months after surgery my tricuspid insufficiency decreased from 3+ to a 1+ on my cardio's scale. Now though 4 years later, the leakage in my tricuspid valve seems to get slightly worse as the time progresses but now that my heart is stronger it does not have as much of an impact on me. But I have to say I'll always have that fear of them saying it's really bad and need some sort of action. Those darn tricky tricuspids!
August 22nd, 2006, 05:53 PM
The test for the liver functions, as there is backward flow of blood through the hepatic veins, I believe. Shows up on the echo. One of the gold standards for severe leakage of that valve. My husband's tests have always come out in the high normal range though., I'll bet that's not the same thing with Joe though (Nancy's husband.
The leads for a pacemaker can go through other areas. Our understanding is that it doesn;t work as well though. They were initially talking about coing through the coronary sinus with my husband, but it seems that has been scrapped. Time will tell.
August 22nd, 2006, 06:40 PM
Strangely enough, Joe's liver function tests have historically been not too bad. He was tested all the time when on Tracleer, and he was usually OK. However, he does have an enlarged liver and spleen and there is evidence of portal hypertension and esophageal varices (Grade 1), and then there is the pulmonarey hypertension. All of this stuff is interrelated.
August 22nd, 2006, 07:53 PM
I think it's important to note the backward flow with severe leakage can eventually damage the liver as well. I think my Card was just as concerned with my liver as he was my heart. They actaully detected a small pool of blood around my liver. Although a biopsy proved that the liver function was fine, it did somewhat mystify some of the doctors.
Of course Ebsteins is different in the fact there can be Atrialization where part of the right ventrical is part of the right atruim due to the displaced valve. Thus creating an abnormal ventical and can reduce effectiveness of it's ability to pump blood to the lungs.
Yes, the Tricuspid valve has less blood pressure than the other valves there for creating a slightly higher risk of blood clot but all you do is keep your INR levels a little higher than other valvers.
August 22nd, 2006, 08:01 PM
That's great you made it to your 40's before you had to have surgery. I know there are varying degrees of Ebsteins. Unfortunately when diasgnosed at a young age as the disease progress it seems like surgery is sooner rather than later. How has Ebsteins affected your life?
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