Tricuspid stenosis

Introduction

Tricuspid valve stenosis is relatively rare and occurs when the leaflets of the tricuspid valve become abnormally stiffened or immobile resulting in impaired right ventricular filling from a decreased tricuspid valve orifice area. This results in increased right atrial pressure and eventual symptoms of right and left heart failure.

Etiology

Rheumatic valvular heart disease is the most common cause; however, carcinoid heart disease, connective tissue disorders (lupus) and cardiac tumors such as right atrial myxomas can cause tricuspid stenosis.

Diagnosis

Diagnosis is predominantly via echocardiography, which can visualize the rheumatically thickened, immobile valve leaflets. Pressure gradients across the tricuspid valve are measured.

Symptoms

Patients with tricuspid stenosis will present with dyspnea on exertion and other signs of right and left heart failure, as well as peripheral edema and right upper quadrant pain from hepatic congestion.

Physical Examination

The murmur of tricuspid stenosis is mid-diastolic at the left lower sternal border (tricuspid listening post). Since venous return increases during inspiration, the murmur can be louder with this maneuver. This is different than Carvallo’s sign which occurs in the setting of tricuspid valve regurgitation.

Treatment

Percutaneous tricuspid balloon valvotomy is frequently successful to relieve the stenosis. Surgical repair or replacement of the tricuspid valve is usually deferred unless cardiac surgery is being done for other purposes, such as repair or replacement of the mitral or aortic valves.