Tricuspid stenosis (TS) most commonly occurs as a late complication of acute rheumatic fever.
TS rarely occurs in the absence of associated rheumatic mitral and/or aortic disease.
Dyspnea is a common finding and usually relates to concomitant mitral valve stenosis.
Prominent a-waves in the jugular venous wave form are a hallmark of tricuspid stenosis in patients who are in sinus rhythm.
Transthoracic echocardiogram with Doppler flow is accurate for diagnosis.
Most effective therapy is valve replacement.
Tricuspid stenosis (TS) is a rare condition defined by an abnormally elevated pressure gradient across the tricuspid valve during diastolic filling of the right ventricle.
History and exam
Key diagnostic factors
- history of acute rheumatic fever (ARF) during childhood
- elevated jugular venous pressure with prominent a-wave
- low-frequency presystolic (diastolic) murmur at lower left sternal border
Other diagnostic factors
- age: 40 to 59 years
- exercise intolerance
- jugular pulsations
- abdominal swelling and discomfort
- cyanosis or hypoxemia
- atrial fibrillation
- ascites, edema, anasarca
- age: infancy or childhood
- episodic facial flushing, watery diarrhea, or bronchoconstriction
- absent right ventricular lift or heave
- opening snap
- endocarditis stigmata (e.g., splinter hemorrhages, Osler nodes, Janeway lesions)
- group A streptococcal (GAS) pharyngitis
- metastatic carcinoid tumors
- artificial tricuspid valve
- intravenous drug use
- pacemaker/defibrillator leads crossing tricuspid valve orifice
- genetic predisposition and environmental factors
1st investigations to order
- chest x-ray
- 2D transthoracic echocardiogram
- Doppler transthoracic echocardiogram
- liver function tests
- blood biochemistry
- blood cultures
- 24-hour urinary excretion of 5-hydroxy-indole acetic acid (5-HIAA)
Investigations to consider
- cardiac catheterization
- cardiac MRI
- 3D transthoracic echocardiogram
with carcinoid heart disease
with rheumatic fever sequelae
with infective endocarditis
- Cardiac tumors
- Systemic lupus erythematosus (SLE)
- Constrictive pericarditis (CP)
- 2021 ESC/EACTS guidelines for the management of valvular heart disease
- 2020 ACC/AHA guideline for the management of patients with valvular heart disease
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