When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Tricuspid stenosis

Last reviewed: 18 Aug 2025
Last updated: 02 Apr 2025

Summary

Definition

History and exam

Key diagnostic factors

  • history of acute rheumatic fever (ARF) during childhood
  • dyspnoea
  • elevated jugular venous pressure with prominent a-wave
  • low-frequency pre-systolic (diastolic) murmur at lower left sternal border
Full details

Other diagnostic factors

  • age: 20-39 years
  • exercise intolerance
  • fatigue
  • jugular pulsations
  • abdominal swelling and discomfort
  • oedema
  • cyanosis or hypoxaemia
  • atrial fibrillation
  • hepatomegaly
  • ascites, oedema, anasarca
  • age: infancy or childhood
  • episodic facial flushing, watery diarrhoea, or bronchoconstriction
  • absent right ventricular lift or heave
  • opening snap
  • endocarditis stigmata (e.g., splinter haemorrhages, Osler nodes, Janeway lesions)
Full details

Risk factors

  • group A streptococcal (GAS) pharyngitis
  • metastatic carcinoid tumours
  • artificial tricuspid valve
  • intravenous drug use
  • pacemaker/defibrillator leads crossing tricuspid valve orifice
  • genetic predisposition and environmental factors
Full details

Diagnostic tests

1st tests to order

  • ECG
  • chest x-ray
  • 2D transthoracic echocardiogram
  • Doppler transthoracic echocardiogram
  • liver function tests
  • blood biochemistry
  • FBC
  • blood cultures
  • 24-hour urinary excretion of 5-hydroxy-indole acetic acid (5-HIAA)
Full details

Tests to consider

  • cardiac catheterisation
  • cardiac MRI
  • 3D transthoracic echocardiogram
  • cardiac CT angiography (CTA)
  • [18F] fluorodeoxyglucose (FDG)-PET/CT
Full details

Treatment algorithm

ACUTE

congenital

with carcinoid heart disease

with rheumatic fever sequelae

with infective endocarditis

Contributors

Authors

John R. Charpie, MD, PhD
John R. Charpie

Professor

Pediatrics and Communicable Diseases

Division Director

Pediatric Cardiology

Medical Director

Pediatric Cardiothoracic ICU

University of Michigan Congenital Heart Center

Ann Arbor

MI

Disclosures

JRC declares that he has no competing interests.

Jeffrey D. Zampi, MD
Jeffrey D. Zampi

Associate Professor

Pediatrics and Communicable Diseases

Director, Interventional Pediatric Cardiology

University of Michigan Congenital Heart Center

Ann Arbor

MI

Disclosures

JZ is a consultant for Medtronic Inc and Gore Medical. JZ serves on the data safety monitoring board for a clinical trial sponsored by Encore Medical. JZ has served as medical expert for several legal cases.

Amanda D. McCormick MD, null

Assistant Professor​

Pediatrics and Communicable Diseases

University of Michigan Congenital Heart Center

Ann Arbor

MI

Disclosures

ADM receives grant funding from the NIH.

Acknowledgements

Dr John R. Charpie, Dr Jeffrey D. Zampi, and Dr Amanda D. McCormick would like to gratefully acknowledge Dr Martin L. Bocks, a previous contributor to this topic.

Disclosures

MLB declares that he has no competing interests.

Peer reviewers

Lokesh Tejwani, MD, FACC

Assistant Professor of Clinical Medicine

University of Missouri Hospitals and Clinics

Harry S. Truman VA Hospital

Columbia

MO

Disclosures

LT declares that he has no competing interests.

John Coltart, MD, FRCP, FACC, FESC, MRCS

Consultant Cardiologist

Cardio-thoracic Unit

Guy's and St Thomas' Hospital

London

UK

利益声明

JC declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

参考文献

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

关键文献

WHO guideline on the prevention and diagnosis of rheumatic fever and rheumatic heart disease [Internet]. Geneva: World Health Organization; 2024.全文  摘要

Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease. EuroIntervention. 2022 Feb 4;17(14):e1126-96.全文  摘要

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Tricuspid stenosis images
  • 鉴别诊断

    • Cardiac tumours
    • Systemic lupus erythematosus (SLE)
    • Constrictive pericarditis (CP)
    更多 鉴别诊断
  • 指南

    • The tricuspid valve: a review of pathology, imaging and current treatment options: a scientific statement from the American Heart Association
    • 2023 ESC guidelines for the management of endocarditis
    更多 指南
  • padlock-locked登录或订阅即可浏览 BMJ Best Practice 临床实践完整内容

内容使用需遵循免责声明