In tricuspid stenosis narrowing of the tricuspid valve results in a persistent diastolic pressure gradient between the right atrium to the right ventricle.
The most common cause of acquired tricuspid stenosis is rheumatic fever.
Congenital tricuspid atresia typically presents with early cyanosis and additional associated congenital heart defects which determine the severity and phenotype.
The presentation of clinically significant tricuspid stenosis depends on whether or not there is accompanying mitral valve disease.
Most patients with clinically significant tricuspid stenosis do also have accompanying mitral valve pathology as well as some degree of tricuspid regurgitation, and present with abdominal discomfort, hepatomegaly, and hepatic congestion. Patients may also complain of a fluttering sensation in the neck caused by tall jugular venous A waves.
In the absence_of mitral valve disease, a patient with clinically significant tricuspid stenosis may present with fatigue and signs of systemic venous hypertension which are characteristically out of proportion to the dyspnea._
Tricuspid stenosis (TS) causes a diastolic rumble at the left fourth interspace. As in mitral stenosis, it may be accompanied by an opening snap.
The intensity of the murmur increases with maneuvers that increase preload and enhance the diastolic pressure gradient, including inspiration, leg raise,inhalation of amyl nitrate, and squatting.
Although Carvallo’s sign (increased murmur intensity with inspiration) is most often associated with tricuspid regurgitation, it is a feature of all right-sided heart murmurs--including tricuspid stenosis.
Chest X-ray may show dilatation of the right atrium.
Echocardiography with doppler demonstrates limited mobility of the tricuspid leaflets, diastolic doming of the valve, and high-pressure turbulent flow across the narrowed opening.
Isolated, asymptomatic tricuspid stenosis does not require treatment; however, patients with symptoms of systemic venous hypertension and congestion should be considered for balloon valvotomy.
If there is accompanying symptomatic mitral or aortic valve disease for which valvuloplasty is indicated in a patient with signs and symptoms of tricuspid stenosis, then replacement of the tricuspid valve is indicated at the time of surgery.