What Are the Stages of Tricuspid Regurgitation?

Based on several variables, there are four stages of tricuspid regurgitation. Depending on the condition's stage and symptoms, other treatments may be used, such as careful waiting or, in certain situations, surgery.

One form of heart disease called tricuspid regurgitation is brought on by the tricuspid valve's improper closure. Blood may flow from the right ventricle, a part of the heart, to the right atrium in reverse as a result of it.

Tricuspid regurgitation is categorised into stages A through D by the American College of Cardiology (ACC) and American Heart Association (AHA)Trusted Source according to:
  • valve anatomy
  • symptoms
  • severity of valve dysfunction
This article looks at the many stages of tricuspid regurgitation and how each is treated.

Where is the tricuspid valve?

One of the heart's four valves is the tricuspid valve. On the right side of the heart, it is situated in the space between the two chambers. Problems with the following can lead to tricuspid regurgitation:
  • Tricuspid leaflets: The valve consists of three tissue flaps.
  • Papillary muscles: muscles that tighten to shut the valve
  • Chordae: tiny, stringy structures that enable the valve to be closed by the papillary muscles
  • Annulus: the framework that serves as the three leaflets' attachment

At risk of tricuspid regurgitation

Those who are at risk of tricuspid regurgitation but do not have structural cardiac problems are classified as having stage A tricuspid regurgitation according to the ACC and AHA guidelines.

Transthoracic echocardiography is a test that may reveal relatively little retrograde flow through the tricuspid valve to medical professionals. The leaflets' and annulus's structures are normal.

In the general population, up to 85% of people have some degree of tricuspid regurgitation, but most never encounter problems.

Progressive tricuspid regurgitation

Progressive tricuspid regurgitation (stage B) is defined by the ACC and AHA recommendations as a regurgitant volume, or volume of blood moving backwards, of less than 45 millilitres (mL).

In stage B, there could be a mild to moderate tethering of the leaflets and an expanded annulus. Tethering is the process by which the stringy chordae draw the leaflets away from their usual position.

There are no symptoms in people with stage B tricuspid regurgitation.

Asymptomatic severe tricuspid regurgitation

Individuals with stage C exhibit severe annular enlargement, tethering of the leaflets, and a regurgitant volume greater than 45 mL. The atrium and right ventricle are larger.

At this point, no symptoms are seen in the population.

Symptomatic severe tricuspid regurgitation

Individuals who have stage D tricuspid regurgitation exhibit leaflet tethering and significant annular enlargement. Additionally swollen are the atrium and right ventricle.

Individuals may have signs of heart failure on the right side.

Among the symptoms are:
  • pulsing in the neck veins
  • abdominal swelling
  • swelling in legs, ankles, or feet
  • weakness
  • fatigue
  • enlarged liver

How are the stages of tricuspid regurgitation diagnosed?

The main tool used by medical professionals to gauge the phases of tricuspid regurgitation is transthoracic echocardiography. A physician might also do the following tests to identify each stage:
  • MRI scan
  • cardiac catheterization
  • electrocardiogram
  • chest X-rays

How is tricuspid regurgitation treated by stage?

This is a look at the many stages of treatment for tricuspid regurgitation.

Stage A: Treatment for tricuspid regurgitation in stage A is usually not necessary.

Stage B: According to the ACC and AHA guidelines, patients with stage B illness who are having left-sided valve surgery and have one of the following conditions should receive tricuspid valve surgery:
  • an annulus that is larger than four centimetres
  • earlier signs of heart failure on the right side

Stages C and D: Diuretics may help manage fluid build-up in patients with stages C and D of the disease, which is a more severe form of the condition.

For patients with stage C or D illness undergoing left-sided valve surgery, the ACC and AHA recommendations advocate tricuspid valve surgery.

As per the guidelines, individuals with stage D and symptoms of right-sided heart failure may find relief from their symptoms through surgery.

Patients with increasing enlargement of the right ventricle and stage C illness may be candidates for surgery.

When to contact a doctor

Individuals who have slow-developing heart valve disease frequently don't exhibit any symptoms. Heart valve dysfunction symptoms that could appear soon include:
  • shortness of breath
  • irregular heart rate
  • fainting
  • fever
  • rapid weight gain
  • chest pain
  • fatigue
  • dizziness
If you start to experience heart valve disease symptoms, get medical help. If you have already been diagnosed with tricuspid dysfunction, you must attend all of your planned follow-up appointments.


Can you live a long life with tricuspid regurgitation?

A 2022 study states that heart failure with decreased ejection fraction (HFrEF) and severe tricuspid regurgitation (TR) have an average 5-year death rate of almost 34%. Heart failure brought on by reduced blood flow from the heart's left ventricle with each beat is known as HFrEF.

Is walking good for leaky heart valves?

For those who have heart valve dysfunction, this is a straightforward, secure, and beneficial type of exercise. Walking can be done on a treadmill inside or outdoors, depending on one's degree of fitness. Studies indicate that it may lower the risk of heart problems.

Can tricuspid regurgitation go away?

While moderate or severe TR can and typically does, mild TR rarely lasts or worsens. Lastly, pulmonary vascular disease or long-standing, possibly irreversible right ventricular dilatation due to the mitral valve are likely additional risk factors for chronic TR.


The disease known as tricuspid regurgitation is characterised by blood flowing backwards via the tricuspid valve. It could be minor or really serious.

The most recent guidelines from the ACC and AHA categorise tricuspid regurgitation into phases A–D. Those with a moderate version of the condition frequently experience no problems at all, while those with a severe variety frequently require surgery.

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