This presentation contains details of clinical features, diagnosis and management of tricuspid stenosis

1. Tricuspid Stenosis
M. Jude Nilshan Fernando
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2. Tricuspid stenosis
• Uncommon valve lesion
• More common in female than in males
• Usually due to rheumatic heart disease
• Frequently associated with mitral and/or
aortic valve disease
• TS is also seen in carcinoid syndrome
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3. Pathophysiology
• Reduced cardiac output
• R/ atrial pressure increases
• Systemic venous congestion
• Produces hepatomegaly, ascites &
dependent oedema
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4. Symptoms
• They complain the symptoms due to left
sided rheumatic valve lesions
• Abdominal pain (hepatomegaly)
• Swelling (acites)
• Peripheral oedema (relatively severe
when compared with the degree of
dyspnea)
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5. Signs
• If the patient is in sinus rhythm
– Prominent jugular venous ‘a’ wave
– Pre systolic pulsation may felt over liver
• Rumbling mid-diastolic murmur
– Best heard at lower left sternal edge
– Louder in inspiration
– (may missed –murmur of MS)
• Tricuspid opening snap may heard
• Hepatomegaly, abdominal ascites, dependent
oedema
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6. Investigations
• Chest X-ray
– Prominent R/ atrial bulge
• ECG
– Enlarged r/ atrium
• Peaked, tall P waves (>3mm) in lead II
• Echocardiogram
– May show thickened, immobile tricuspid valve
– Not clearly seen as abnormal mitral valve
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7. Treatment
• Diuretic therapy & salt restriction
• Tricuspid valvotomy
• Other valves usually also need
replacement because tricuspid stenosis
is rarely an isolated lesion
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8. Tricuspid regurgitation
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9. Tricuspid regurgitation
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Organic TRFunctional TR
• Occur
whenever the
R / ventricle
dilates
• Co-pulmonale
• MI
• Pulmonary
Hypertension
• Occur with
• Rheumatic heart
disease
• Infective
endocarditis
• Carcinoid
syndrome
• Ebstein’s
anomaly

10. Symptoms
• Due to high right atrial and systemic
venous pressure
• Patient may complain the symptoms of R
heart failure
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11. Signs
• Large jugular venous ‘cv’ wave
• Palpable liver that pulsates in systole
• R/ ventricular impulse may felt at L/
sternal edge
• Blowing pansystolic murmur
• Best heard on inspiration
• At the lower sternal edge
• Atrial fibrillation is common
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12. Investigations
• Echo shows
– Dialated R ventricle
– with thickening of valve
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13. Treatment
• Functional TR
– Usually disappear with medical management
• Severe organic TR
– May require operative repair of the
tricuspid valve
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