Tricuspid stenosis

It is usually rheumatic in origin and nearly always occurs in associated with mitral and aortic valve disease. Tricuspid valve stenosis is a valvular heart disease which results in the narrowing of the orifice of the tricuspid valve of the heart . It is a relatively rare condition that causes stenosisincreased resistance to blood flow through the valve.

Causes: It is almost always caused by rheumatic fever and is generally accompanied by mitral stenosis. Rare other causes include carcinoid syndrome, endocarditis, endomyocardial fibrosis, lupus erythematosus, right atrial myxoma and congenital tricuspid atresia.

Clinical features:

Symptoms:

1.      Symptoms of associated mitral or aortic valve disease.

2.      Symptoms of right heart failure.

·         Abdominal swelling.

·         Hepatic discomfort.

·         Peripheral oedema.

·         Fatigue.

Signs:

1.      Raised JVP with a prominent ‘a’ wave & a show ‘y’ descent.

2.      Mid diastolic murmur-increased by inspiration.

3.      RHF-hepatomegaly, ascites, peripheral oedema.

Investigations:

1.      Chest X-ray:

·         Enlarged right atrium (non specific for TS)

2.      Echo:

·         Fused, thickened tricuspid valve.

·         Dilated right atrium, Doppler features of TS.

Management:

1.      In patients who require surgery to other valve, tricuspid valve is either replaced or subjected to valvotomy at the time of surgery.

2.      Balloon valvuloplasty in rare cases of isolated tricuspid stenosis.

Reference:

1.      Davidson’s Principles and practice of Medicine, 21^st edition.

2.      Wikipedia the free encyclopedia.