Tricuspid stenosis
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| Tricuspid stenosis Classification and external resources | |
| ICD-10 | I07.0, I36.0, Q22.4 |
|---|---|
| ICD-9 | 397.0, 746.9 |
| DiseasesDB | 13353 |
| eMedicine | med/2315 |
| MeSH | D014264 |
| Cardiology Network |
 Discuss Tricuspid stenosis further in the WikiDoc Cardiology Network |
| Adult Congenital |
|---|
| Biomarkers |
| Cardiac Rehabilitation |
| Congestive Heart Failure |
| CT Angiography |
| Echocardiography |
| Electrophysiology |
| Cardiology General |
| Genetics |
| Health Economics |
| Hypertension |
| Interventional Cardiology |
| MRI |
| Nuclear Cardiology |
| Peripheral Arterial Disease |
| Prevention |
| Public Policy |
| Pulmonary Embolism |
| Stable Angina |
| Valvular Heart Disease |
| Vascular Medicine |
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Tricuspid valve stenosis is a valvular heart disease which results in the narrowing of the orifice of the tricuspid valve of the heart. This causes increased resistance to blood flow through the valve. It is almost always caused by rheumatic fever and is generally accompanied by mitral stenosis.
Pathophysiology
The tricuspid valve leaflets become thickened and sclerotic as the chordae tendineae become shortened. As a result of increased diastolic pressure, right atrial enlargement may be present.
Common Cause
- Rheumatic fever: Scarring associated with the disease will increase the valve's susceptibility to hardening
Complete Differential Diagnosis of Underlying Causes
- Thrombus on a pacemaker (either temporary or permanent) wire
- Rheumatic fever: Scarring associated with the disease will increase the valve's susceptibility to hardening
- Ebstein's anomaly
- Endomyocardial fibrosis
- Lupus erythematosus
- Endocarditis
- Congenital tricuspid atresia: A malformation of the tricuspid valve present at birth
- Right atrial tumor: Abnormal growth in the right atrium near the tricuspid valve, which can block the opening of the valve
- Carcinoid syndrome: Change in tissue characteristics of the cells effects the tricuspid valve
Symptoms
The onset of symptoms in the patient with tricuspid stenosis is often gradual and may be associated with some or all of the following symptoms:
- Dyspnea may be present if there is associated mitral valve disease
- Fatigue
- Systemic venous congestion may lead to abdominal discomfort due to hepatomegaly
- Abdominal swelling
- A fluttering discomfort or complaints about prominent pulsations in the neck may be present
- Leg and ankle swelling (pedal edema)
Diagnosis
Physical Examination
Vital signs
A pulsus paradoxus may be present.
Neck
An elevated jugular venous pulse may be present.
Heart
A mid diastolic murmur can be heard during auscultation caused by the blood flow through the stenotic valve. It is best heard over the left sternal border with rumbling character and tricuspid opening snap with wide splitting S1. The murmur of tricuspid stenosis may increase in intensity with inspiration (Carvallo's sign).
Echocardiography
The diagnosis and the severity can be assessed by echocardiography [1].
2D-Echocardiography
- Thickening of valve leaflets
- Calcification
- restricted mobility
- " Doming " of the leaflets
Doppler Echocardiography
- Severity can be assessed by the transvalvular gradient
- Using continuous wave doppler across the tricuspid valve in apical-4-chamber view. The peak gradient can be calculated using the modified Bernoulli equation.
- Pressure half time can be used but is not validated for triscuspid stenosis.
- calculation of Tricuspid valve area with the continuity equation
- Tricuspid valve area = ( annulus PW Vti * Cross sectional area of the annulus) / valve CW Vti
Assessment of tricuspid stenosis severity with echocardiography
| Severity | mild | moderate | severe |
|---|---|---|---|
| Tricuspid valve area | - | - | <1 |
| Mean Pressure Gradient | <4 | 4-7 | >7 |
Differential diagnosis of a tricuspid mass causing obstruction
- Right atrial tumour
- Right atrial ball valve thrombus
- Large vegetations
Cardiac Catheterization
During diastole, there is a gradient between the right atrial (RA) and right ventricular (RV) diastolic pressure (RA is higher than RVEDP). A large a wave may be seen on the RA tracing.
Treatment
The treatment is usually by surgery (tricuspid valve replacement) or percutaneous balloon valvuloplasty. The resultant tricuspid regurgitation from percutaneous treatment is better tolerated than insufficiency that occurs following mitral valvuloplasty
See also
References
Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
