Tricuspid Stenosis
Definition
A narrowing of the tricuspid valve orifice
Etiology
- Rheumatic fever (most common)
- Carcinoid
- Congenital
- Right atrial tumors/clot
- Endocardial fibroelastosis
Signs and Symptoms
- Peripheral edema
- Abdominal swelling
- Right upper quadrant pain
- Less evidence of pulmonary congestion
- Jaundice, Ascites
Complications
- Increased risk of infective endocarditis
Cardiac Auscultation
- Opening snap
- Diastolic rumble best heard along the lower Left sternal border
- Both the opening snap and the diastolic rumble may be accentuated with inspiration
Electrocardiogram
- Right atria! enlargement
- Biatrial enlargement
- Atrial fibrillation
Chest X-ray
- Right atrial enlargement
Treatment
- Commissurotomy
- Valve repair/valve replacement
Tricuspid Stenosis Severity Scale
- Valve area: Normal 7 to 9 cm2
- Severe < 2.0 cm2
M-Mode
- Thickened tricuspid valve leaflets.
- Decreased E-F slope of the tricuspid valve
- Anterior motion of the posterior tricuspid valve leaflet
2-D
- Thickened tricuspid valve leaflets, especially at leaflet tips
- Diastolic "doming" of the tricuspid valve
- Right atrial enlargement
- Dilated inferior vena cava (normal: 1. 2 to 2. 3 cm)
Doppler
- Turbulent flow
- Increased velocity of the tricuspid inflow recorded at the tricuspid leaflet tips (> 1. 0 m/sec)
- Decreased E-F slope of the tricuspid inflow Doppler tracing (indicates an increased pressure half-time)
- Determine the pressure half-time, using the formula for mitral stenosis
- Determine the tricuspid valve area by the formula: 220/PHT
- Determine the mean pressure gradient
- Determine the presence and severity of tricuspid regurgitation
Important to Note
Tricuspid stenosis almost never occurs as an isolated lesion; it generally accompanies mitral stenosis, so evaluate for mitral, aortic, and pulmonic valve disease due to rheumatic fever.