Tricuspid Stenosis

Tricuspid stenosis is usually rheumatic in origin. It should be suspected when "right heart failure" appears in the course of mitral valve disease, marked by hepatomegaly, ascites, and dependent edema. It may also occur in carcinoid syndrome. The typical diastolic rumble along the lower left sternal border mimics mitral stenosis. In sinus rhythm, a presystolic liver pulsation may be found.

Hemodynamically, a diastolic pressure gradient of 5-15 mm Hg is found across the tricuspid valve in conjunction with raised pressure in the right atrium and jugular veins, with prominent a waves and with a slow y descent because of slow right ventricular filling.

Echocardiography usually demonstrates the lesion, and Doppler flow studies can measure the gradient; accompanying valve lesions can also be detected. Right heart catheterization is diagnostic.

Acquired tricuspid stenosis may be amenable to valvotomy under direct vision, but it usually requires a prosthetic valve replacement. Although experience is limited, balloon valvuloplasty may be the initial procedure of choice in many patients.