What Comes Next: Tricuspid Regurgitation
Making Sense of Your Diagnosis
Reviewed by Columbia Structural Heart and Valve Center Faculty, September 2025
If you've just been diagnosed with tricuspid regurgitation, you may have a lot of questions—and some understandable worry. Many people aren't familiar with this condition until they hear about it from a doctor, so you're not alone in feeling unsure about what it means or what happens next.
Our What Comes Next series is designed to help you sort through the most common questions patients ask after a diagnosis—and to help you feel more informed and in control.
I've Been Diagnosed With Tricuspid Regurgitation. How Serious Is It?
Tricuspid regurgitation (TR) can range from mild to torrential. In some patients, it causes no symptoms and may not require treatment right away. But in more advanced cases, it can cause the heart to work harder, leading to symptoms and complications like heart failure, liver congestion, or abnormal heart rhythms.
Tricuspid regurgitation happens when the tricuspid valve—which separates the right upper chamber (atrium) from the right lower chamber (ventricle)—doesn't close tightly. This allows blood to leak backward into the atrium instead of moving forward into the lungs. Over time, this can lead to strain on the heart and put pressure on the liver and kidneys.
What Causes Tricuspid Regurgitation?
TR can be caused by a number of things, including:
- Enlargement of the right side of the heart (often from other heart conditions like left-sided heart failure or pulmonary hypertension)
- Atrial Fibrillation
- Damage from a pacemaker or ICD lead
- Trauma or prior heart surgery
- Damage to the valve from infection (endocarditis)
- Congenital heart defects
- Rheumatic heart disease
- A condition called functional TR, which means the valve itself is normal, but is pulled apart by an enlarged or weakened heart
I Don't Feel Sick. Could My TR Still Be a Problem?
Possibly. Many people with TR don't notice symptoms at first. But even if you feel fine, your heart may be under strain. Over time, TR can lead to symptoms like:
- Swelling in the legs, abdomen, or neck veins
- Fatigue
- Shortness of breath
- Irregular heartbeats (arrhythmias)
- Reduced ability to exercise
Your cardiologist will keep a close eye on your heart function through imaging tests, even if you're not having symptoms now.
Will I Need A Procedure?
Not necessarily. Many cases of mild or moderate TR can be managed with medications and careful monitoring. But if TR becomes worse—especially if it's causing symptoms or changes in heart function—your doctor may recommend treatment.
Surgical or transcatheter procedures to repair or replace the tricuspid valve are options for more advanced cases. Treatment decisions depend on how severe the regurgitation is, whether it's progressing, and your overall health.
Are There Less Invasive Options?
Yes. In the past, open-heart surgery was the only option for severe TR. But now, transcatheter treatments (similar to TAVR or MitraClip procedures used for other valves) are emerging as less invasive alternatives for certain patients. Both the Edwards EVOQUE Tricuspid Valve Replacement System as well as the Abbott TriClip system for transcatheter repair recently received FDA approval, and more devices designed to treat tricuspid regurgitation are currently undergoing clinical trials.
These catheter-based procedures are performed through a vein in the leg, avoiding the need for open surgery. That often translates to shorter hospital stays and faster recovery. Not all patients are candidates, but these options are expanding quickly.
Can Medications Help?
While medications can't fix TR, they can help manage symptoms and reduce strain on the heart. These medications may include:
- Diuretics to reduce fluid buildup (swelling)
- Medications to manage high blood pressure or heart failure
- Anti-arrhythmic medications if irregular heartbeats are present
Medication is often the first step for managing TR and may delay or avoid the need for surgery.
Can TR Be Cured?
There's no cure for TR without intervention—but it can often be managed successfully. In mild cases, it may stay stable for years with no symptoms. In more advanced cases, surgery or a transcatheter procedure can often reduce or eliminate the leakage, improving quality of life and heart function.
How Will I Know If It's Getting Worse?
Your cardiologist will monitor your condition with regular echocardiograms (ultrasound of the heart), physical exams, and check-ins about your symptoms. If you begin to feel more tired, more swollen, or more short of breath, let your care team know right away.
Changes in your EKG or imaging results may also indicate progression, even before you feel symptoms.
Will Treating TR Help Me Feel Better?
Yes, especially if you're having symptoms. Many patients notice reduced swelling, improved energy, and better exercise tolerance after treatment. The right therapy—whether medications or a procedure—can make a major difference in how you feel day to day.
Will Treatment Help Me Live Longer?
Treating severe TR can reduce your risk of heart failure, arrhythmias, and other complications. For some patients, early treatment can also improve long-term survival. That's why staying closely connected with your heart team—and acting early when symptoms arise—is so important.
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