Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 10-16: Tricuspid Stenosis + Key Features Download Section PDF Listen +++ +++ Essentials of Diagnosis ++ Female predominance Right heart failure after rheumatic heart disease, tricuspid valve repair or replacement, and carcinoid disease are the most common causes in the United States Elevated jugular venous pulsations (JVP) with prominent a wave Echocardiography/Doppler is diagnostic; mean valve gradient > 5 mm Hg or tricuspid valve area < 1.0 cm2 indicates severe tricuspid stenosis +++ General Considerations ++ Rare; affects < 1% of the population in developed countries and < 3% worldwide Is frequently accompanied by tricuspid regurgitation The incidence of tricuspid stenosis after tricuspid valve replacement increases considerably 8 years post surgery Combination should be suspected when "right heart failure" appears in mitral valve disease or postoperatively after tricuspid valve repair or replacement Congenital form may be seen Multiple pacemaker leads can create right ventricular (RV) inflow obstruction at the tricuspid valve (case reports) + Clinical Findings Download Section PDF Listen +++ +++ Symptoms and Signs ++ Right heart failure with hepatomegaly, ascites, and dependent edema In sinus rhythm, a giant a wave in the JVP, which is elevated Typical diastolic rumble along the lower left sternal border (mimics mitral stenosis, although it increases with inspiration) In sinus rhythm, a presystolic liver pulsation may be found Should be considered when patients exhibit signs of carcinoid syndrome + Diagnosis Download Section PDF Listen +++ +++ Imaging Studies ++ Chest radiograph findings Marked cardiomegaly with a normal pulmonary artery (PA) size Dilated superior vena cava (SVC) and azygous vein +++ Diagnostic Studies ++ In the absence of atrial fibrillation, the ECG reveals right atrial (RA) enlargement The normal tricuspid valve area is 10 cm2, so significant stenosis must be present to produce a gradient A mean diastolic pressure gradient > 5 mm Hg is considered hemodynamically significant, although even a 2 mm Hg gradient is abnormal + Treatment Download Section PDF Listen +++ +++ Medications ++ Diuretics are mainstay in reducing the fluid congestion Torsemide and bumetanide may have an advantage over furosemide and other loop diuretics when there is considerable bowel edema because they are better absorbed from the gut Aldosterone inhibitors (eg, spironolactone) also help, particularly if there is liver engorgement or ascites +++ Surgery ++ Neither surgical nor percutaneous valvuloplasty is particularly effective, since residual tricuspid regurgitation is common Tricuspid valve replacement is the preferred surgical approach Bioprosthetic tricuspid valves are almost always used Mechanical tricuspid valve replacement is now rarely done Percutaneous transcatheter valve replacement (stented valve) has been used in degenerative tricuspid prosthetic valve stenosis + Outcome Download Section PDF Listen +++ +++ Prognosis ++ May be progressive, eventually causing severe right-sided heart failure +++ When to Refer ++ All patients with any evidence for tricuspid stenosis on an echocardiogram should be seen and followed by a cardiologist to assess when intervention may be required + References Download Section PDF Listen +++ + +Al-Hijii M et al. The forgotten valve: Isolated severe tricuspid valve stenosis. Circulation. 2015;132:e123–5. [PubMed: 26283605] + +Cevasco M et al. Surgical management of tricuspid stenosis. Ann Cardiothorac Surg. 2017 May;6(3):275–82. [PubMed: 28706872] + +Hirata K et al. Bioprosthetic tricuspid valve stenosis: a case series. Eur Heart J Case Rep. 2019 Sep 1;3(3):ytz110. [PubMed: 31367735] + +Hong SN. Carcinoid heart disease. J Am Coll Cardiol. 2010 May 4;55(18):1996. [PubMed: 20430272] + +Petit CJ et al. Melody valve implantation in the pulmonary and tricuspid position. Catheter Cardiovasc Interv. 2013 Dec 1;82(7):E944–6. [PubMed: 23197462] + +Rana G et al. Percutaneous valvuloplasty for bioprosthetic tricuspid valve stenosis. Tex Heart Inst J. 2017 Feb 1;44:43–9. [PubMed: 28265212]