Tricuspid Valve Regurgitation

[M&M]

Hi all, I had a mitral valve replacement last May and I just got my one year echo done and it now says my tricuspid valve is moderate (2+/4+) regurgitation.. But theEcho said the view 'quality' was FAIR - so maybe its wrong..

But is it common to have one valve regurgitation and then go to another right afterwards? I wonder what causes that. Perhaps a second opinion would be good.

Anyways, do people normally get another leaky valve after replacements?
Is this common?

Marilyn (runner)

 

[Nancy]

My husband has had tricuspid regurg. for many years. He's had many opinions on it, and no one wants to go in and fix it. I believe that this is often the case. I read that some congenital defects in that valve are fixed, but mostly they try to manage the symptoms medically if it is not.

Right now, Joe has sometimes serious, right-sided heart failure but there is still no mention of doing any other repair work. He's already had three valve surgeries, and as it stands now, that's it.

 

[Mb]

Dear Marilyn:

My husband had his valve surgery 3-/12 years ago. He sports two St. Jude valves, one aortic and one mitral valve. He is in chronic persistent a-fib.
Post surgery, he did not recover as well as thought he might, and he had another echo done at three months, when voila! His tricuspid valve had a moderate leak. Over the next year or so, it progressed to severe.

It is my understanding that mitral valve regurgiation often "masks" the severity of tricuspid regurgitation, and if the tricuspid is not repaired at the time of the mitral valve operation, then the regurgitation will show itself post surgery. My husbands previous echo's had shown mild TR presurgery, and then moderate post surgery, and then now he has severe reguritation. He is managed with meds up to now. Our last visit with the cardio in January the topic came up again, at which time the cardio said he thinks it should get fixed prior to his going into other organ failure (kidney and liver). His ehco had said the pressures in his heart had increased, backflow of blood into the liver, and he has thrown some clots as well. So, he gets tested again in August, at which time the subject no doubt will come up again. Oh, he also had TEE done, and it was determined that the annulos had become too large for the flap of the valve to close over it tightly, so this is why it regurgitates. So, we shall see where the next test brings us.

I do not think this is a common event, from what I've read here. I believe Nancy's husbands problems stem from his PH, and not the enlargments of the atria from the a-fib. I am confident that you are not looking at surgery really quickly, if at all. This is truly something they have great luck with controlling with medications.

I wish you the best,. - Marybeth

 

[M&M]

Thank You So Much Nancy and Marybeth for responding - I have been so upset since getting the results of my first echo. I've had problems breathing again - like before I had my mitral surgery - only not as severe - but very similar and I don't have been disappointed that I went through all this and its just not going away and wondered if it was ever going to. Then when I saw my tricuspid was regurgitating - I just went into a panic - and dread having to possibly go through surgery again - sometime down the road.

Nancy I wish they could help Joe more - I can't imagine having 3 surgeries. That is so much to go through. He's been through so much and he's come so far and I'm sure it was because you've given so much of your insight and love and I'm sure you stayed right on top of things. I've learned in the past 12 years - you have to stay on top of heart disease - or you just don't survive. Joe is a very lucky man and I'm sure you feel very lucky to have him. Your posts are always so sweet and so very, very informative - I appreciate you taking the time to tell me what you know and what you and Joe have learned over the years.

Marybeth - I know exactly how your husband feels - I had such grand hopes of going back to my former active lifestyle and I just can't do it. I've been very frustrated and kept thinking its got to be my ICD programming and at one point it was. But that's not the case anymore. My doctor just e-mailed me and said I do have 'congestive cardiomyopath' - but its in the early stages I believe. He doesn't know how hard my breathing has been somedays. I kept thinking it was his ICD programming.

But on doing some research I came upon a possible medication (ace inhibitors) that might help - so I may run that by my doctor tomorrow when I get my second echo and see what he thinks. I'm glad to hear that meds might be helpful. They didn't try any meds for my mitral. So there's still hope that I can keep surgery at bay alittle longer. I'm glad to hear they don't go right in before trying meds.

You've both been so sweet - and I can't thank you enough - I feel at least someone can understand what I'm saying and you've given me come hope.

Best Wishes
Marilyn (walker)

 

[Georgia]

Hi, Marilyn - I had an mvr and tricuspid repair at the same time - I was told that the malfunctioning mitral valve caused the tricuspid damage. Do you have engorged carotids? That was my most obvious symptom from the tricuspid problem.

I've been on an ace inhibitor since surgery - it's a good med. It does tend to cause a nagging dry cough - so if you get on it and start coughing, ask for another brand.

Good luck.

 

[nia]

Dear Marilyn,

I had a MVR about two years ago, and my annual echo result indicates a trace tricuspid regurgitation as well as a mild dilation of the right ventricle (with normally-appearing function). However, I have another echo, taken at a different institution about a week prior to the one mentioned first, which says that both the tricuspid valve and the right ventricle are normal.

The cardiologist who explained the first echo said that the dilation was most likely due to the infection, which is what caused me to have the MVR in the first place. So I guess, from her perspective, the tricuspid regurgitation sort of ?tagged along? with the endocarditis? The quality of this echo was ?diagnostically adequate.? I know that my immediate post-op echo also showed tricuspid regurgitation, at the time considered mild. She told me not to worry about it. Easier said than done, but I try.

My main cardiologist, who took the ?all-normal? echo, reviewed the tape for a good 30 min. with the tech, then with me, when I went back to her and mentioned that the other echo found all sorts of interesting things. She still thinks that, even with knowing what prompted the other doctor to say dilation, regurgitation, etc., my valves, etc. are all normal. Naturally, I would like to stick with her results and pretend that the other echo result doesn?t exist. However, I know I just have to keep in mind that my tricuspid and the right side of my heart should also be checked thoroughly whenever I go for the echo that is supposed to evaluate how my mitral valve is doing (along with everything else, of course...)

As your medical background and mine are different, I?m afraid my story cannot really help ease your anxiety. I hope you find good answers from your second echo.

 

[Nancy]

Marilyn-

What we have learned through some very nasty lessons is that control of fluid retention is THE MOST IMPORTANT thing that Joe can do, above and beyond any meds or surgical intervention.

Surgery itself causes problems. It can correct many things, but sometimes there are trade-offs in the form of scar tissues etc.

So Joe's weight limit is no more than three pounds above his "feel good" weight. After that the fluid becomes very hard to get rid of, and with too much diuretic, he goes into kidney failure.

His diet is limited to 500mg sodium per day, and he weighs himself every day. The regimen is restrictive, and the margin is exceedingly tight, but that's the way it has to be done, since surgery is not an option for him.

So, discuss it with your cardiologist and see if you can come up with a similar plan for yourself. You'd be surprised at how well it works. Maybe you could avoid any further surgery.

Is it hard to do? Sure! Is it hard to get used to? Sure. But you are a very discipined woman, and should have no trouble.

 

[Michaelena]

Hi all, I had a mitral valve replacement last May and I just got my one year echo done and it now says my tricuspid valve is moderate (2+/4+) regurgitation.. But theEcho said the view 'quality' was FAIR - so maybe its wrong..

But is it common to have one valve regurgitation and then go to another right afterwards? I wonder what causes that. Perhaps a second opinion would be good.

Anyways, do people normally get another leaky valve after replacements?
Is this common?

Marilyn (runner)

Hi Marilyn,
When my mitral valve was replaced (20 years ago), I was told that my tricuspid was leaking. It took that long for me to be looking at TVR, my aortic valve is also in need of replacment. My valve problems stem from rheumatic fever, I also have chronic a-fib, since MVR.

My quality of life has been impacted as a result of the triscupid problem. I have edema, my liver is engorged, and I tire quickly. I am on a diuretic, low sodium diet, but still have edema. I do not experience the same shortness of breath as I did with my mitral valve problem. I have seen 3 cardiologist, one said that I can, with medication put off surgery for a couple years. My primary care physician is concerned about my right atrium becoming damaged and also my liver. The other two cardiologist concur with my PCP. I have seen 3 surgeons, comparing how each one will go about the surgery, and with the help of all of the information I have received on this web site, and elsewhere, was able to make a decision that I feel comfortable with. So, it's on to surgery, probably the end of July, but first I must see a GI specialist for my liver and also they must check out my carotid (which is moderatly blocked).

I wonder now if something should have been done (repair) for my tricuspid at the time of my mvr, which they knew about. It's water under the bridge, so I must deal with what is right now.

If you are not symtomatic, and your quality of life is not impacted I would just keep on top of it. Only you know how you feel, and if it would make you feel better, get a second opinion. Mine, as you read above progressed over time, which one of the cardio's said that my body just compensated for it, so the impact was not as profound.

Good luck,
Michaelena

 

[Debrinha GT]

During my first MVR...

During my first MVR...

I had my first MVR thirty years ago when I was only ten years old. I remember my cardio telling my mum a few months later that they found a lesion on my tricuspid valve and were able to repair it. I never found out though how serious it was. However, last year in one of my echos, it showed a very mild tricuspid regurgitation but when I got another echo done a few months after that one, there was no mention about that. Now that I come to think of it, I wonder why the echo showed that in the first place!??
Débora

 

[Mb]

Michaealena:

I wonder if you would mind sharing with me, the pressures, LA size, RA size, EF, etc. if you have that info from your echo reports. As I said above, my husband has a very important cardio meeting coming up in August, and I would like to know what your "triggers" are for them to repair/replace your tricuspid valve. Are they more worried about the TV or the Aortic????

I would really appreciate your sharing this info.-Marybeth

 

[M&M]

Thank You All for responding - you've been so helpful and have given me such valuable information. I saw my EP doc yesterday and it was confirmed because of my low EF rate (35%) and my enlarged left ventricle - I do have congested cardiomyopathy - but early stages and I do have 'heart failure' - But my right atrial and right ventricle are not enlarged at this time - just the left ventricle - I don't have edema at this time. He did check my neck - he didn't tell me what he was doing - but he put his finger of my cartoid and pushed in and did it again.. I wanted to ask him to explain himself - but he doesn't like to get into giving lots of 'information' unless the patient ask. He did switch my beta blocker from atenolol to coreg - as I asked how I could improve my EF rate.. So we're going to try the new drug. He said its usually well tollerated.. We discussed my shortness of breath and fatigue. We're hopeing coreg helps with that as well.

I also got my ICD interrogated and I still have enough battery life to go at least another 3 mos. which is good - but I also have one of those potential defective ICD's on the market that has been in the press. He did say I could get it replaced by Guidant - but he didn't think it was necessary and Guidant would not pay for a different brand inplanted and my insurance will not pay for a replacement until the battery is depleted. So, I'm kind of stuck unless I want another Guidant which I'm not feeling safe having the one I have let alone another one of theirs for another 5 years down the road. Of course he went over all the potential risks for replacement surgery of my ICD - and I said at one point -well lets just not bother with this at all. When the battery goes dead why don't we just let it go.. there's to much risk. I'm tempted you know - to say: NO - there will be no new ICD - just let me rest in peace.. I don't need some manufacturer's malfunctioned ICD's that don't work when you need them to work anyways asits just a waste of time.

He said- to come back in 3 mos and if I want I can have another echo done - this one is called the "av dissociation" - as they can program my ICD to react a tiny bit better when I exercise. I can't exercise if I can't get rid of this fatigue. So, I'm hopeing the meds help. I do have some good days and then some bad days and I don't see why things are not consistent. I've had enough tests and I'm just wanting to get my strength back. The thing that bothers me is - I specifically asked if meds would help my moderate/severe leaky mitral valve "before" surgery and they didn't think so and now they think meds are the best route to go !!! I said: after surgery I thought my EF rate would go "up" and he said - No not necessarily - but had you not had the surgery it would have gotten more severe... OK - well my previous echo showed a couple weeks ago showed an EF of 35% and I won't get the results of yesterdays stress echo till maybe late next week and then we'll review via e-mail. :-( I didn't think my stress echo went that good - I didn't get much biking in before I hit my 70% target heart rate -actually they had to stop it alittle before I hit my 70% target heart range - my breathing was not going so well. :-( and I can bike better than jog !!!

Michaelena: When you say:I wonder now if something should have been done (repair) for my tricuspid at the time of my mvr, which they knew about. It's water under the bridge, so I must deal with what is right now.

I agree - its water under the bridge and I don't think my tricuspid was leaking and I'm not so sure I would have been happy if they replaced it and it wasn't leaking. Now my echo says my tricuspid is leading Moderately !!! I asked my doc if this could get as bad like as my mitral and he thought meds would help.

Nancy you said about a low sodium diet: Is it hard to do? Sure! Is it hard to get used to? Sure. But you are a very discipined woman, and should have no trouble.

Thank you for saying how 'disciplined' I am.. I've been told by alot of people that I am and if a special diet will help me to exercise better - I'm going to give it a try and ask my doctor about it and if he has any suggestions for any dieticians to see to help me. Thank you Nancy.. You always give such good advice.

Thanks so much to all of you - taking the time to respond and give me help has been very much appreciated.
Marilyn

 

[Michaelena]

Michaealena:

I wonder if you would mind sharing with me, the pressures, LA size, RA size, EF, etc. if you have that info from your echo reports. As I said above, my husband has a very important cardio meeting coming up in August, and I would like to know what your "triggers" are for them to repair/replace your tricuspid valve. Are they more worried about the TV or the Aortic????

I would really appreciate your sharing this info.-Marybeth

Marybeth,
Sorry, it took so long to reply. I am happy to share my info with you, if I can interprete my reports. Let me answer your last questions first. The doctors are more worried about my TV, I am very symtomatic (edema, fatigue etc) with medication. The tricuspid valve has incomplete coaptation to an impressive degree, with approximately 1 cm between the valve leaflet tips and severe tricuspid regurgitation into a huge right atrium (severely enlarged) per echo report, the calculated RV systolic pressure is 31 mmHG, LA 5.5 cm. The drs are concerned that left alone (with medication) my right atrium would be irreparably damaged, and also my liver will chirrhosis (it is engorged from all of the back flow of blood). It is very unusual that the TV is the primary reason for OHS, but here I am. Since my aortic valve has mild stenosis and moderate regurgitation, and based on my heart valve history, they will replace the aortic, since in a couple of years it will have to be replaced anyway. I already had the mitral valve replaced (rehumatic fever).

I don't have the most recent echo May 05, I am sure that that confirmed the one that I do have a copy of which was done 10/29/04. I just started becoming symtomatic at that time. The LA (left atrium) RA (right atrium), EF?
I just want to make sure what the abbreviations mean, I am medically challanged, and just learning what all of this is about; I know I should have become more proactive about my condition. This web site has taught me a lot, I am amazed at how much just about everyone on here knows about heart valves etc. The echo reports I have are very inconsistant in the way they report the findings, although they were done at the same cardio office, I tried to compare.

I will be getting my most recent echo report, (May 05) and I will let you know pressures etc.

Michaelena

 

[Nancy]

Marilyn-

Coreg is one of the best meds for this condition. Unfortunately, Joe cannot tolerate it or any of its cousins, he just blows up with fluid. Several cards. have tried meds of a similar nature, it was a no go. So, if you can tolerate it, it should do a good job for you.

By the way, Joe was a SUPER athlete in his youth, semi-pro football, pro baseball (minors) and lots of basketball, plus he was a fantastic track guy, and is a triple type A personality and extremely disciplined. He always exercised and loved it, and still exercises as much as possible, It's much to his credit, and is one of the main reasons he is still with us today at 74. He's very strict about his meds, and changing whatever he has to in his life to survive.

Low sodium is hard, but if you look at some of the old posts of mine in the recipe section, you will see links to some great online sources for low and no sodium products. They make a world of difference. The best thing happened this week. Joe loves Italian hot sausage, and he could never have it. I found a terrific Italian deli that makes their own sausage, and they were willing to make some without salt for him. He just thought it was delicious and so did I. He said, "I never thought I would be able to have sausage again in my life."

So there are surprising things that can be done with low or no sodium. Just have to root them out.

I believe in you and that you'll do fine. You've got lots of strength.

 

[Mb]

Dear Michaelena:

Thank you for your reply to my inquiry. I have compared your notes, with those of the most recent echo on my husband. August of 04.

There is no RV systolic number indicated on his report. His right atrium measure 57mm at the superior-inferior. The medial lateral right atrial dimension was 53mm. The right ventricle is dilated, measuring 47mm at the base. Ooops, I just noticed that the right ventricular systolic function was within normal limits. He has all of the symptoms you mention.

We see his cardio in August. If you get more information from your newest echo, I would sincerely appreciate your sharing that info again.

God bless. - Marybeth

 

[M&M]

Thank You Nancy for your input on this drug "coreg" - I'm hoping its tolerated well in my system and it gives me more stamina. I'm sorry Joe was not able to tolerate it. Your so sweet to help so many - Joe sounds like a really swell guy - I feel like I know him from how fondly you speak of him. Being an exercise enthusist myself - I would love to hear all about his track and basketball. I'm sure the exercise has helped immensely - I truly believe it has helped me in so many postivie ways. I might sound as if I have major heart disease - and with congestive cardiomyopathy and previous heart attack and ICD - if you saw me - you would not believe I have all these heart problems.

I'm now trying to decide whether or not to get this Guidant recall ICD replacement out of me and get another ICD - or wait for the battery to die and get a Medtronic ICD. Problem is I still have some time left on this device (Guidant) and so it could be awhile before I'm able to get a Medtronic and Guidant is now recalling more than one device - which means - what's left on the shelf is what I'll probably get inplanted if I go for a replacement now !!! One minute I say: Wait and get a Medtronic and the next - I say - Guidant woudn't dare give us patients another faulty device. But I don't trust Guidant so they could do just that.

There are now two deaths and over 40 malfunction devices that they are reporting. Each day they seem to report more terrible stories and its hard to know which way to turn. Its like the roulette wheel - throw the dice and see where you end up.

Thank god there are nice people on the web that are able to listen and offer hope and some helpful advice. I appreciate it very much..

Take Care My Friend.
Marilyn