Tricuspid valve stenosis
|Tricuspid valve stenosis|
|Other names||Tricuspid stenosis|
|Video explanation of tricuspid disease|
|Symptoms||Tiredness, shortness of breath, leg swelling, liver problems|
|Causes||Rheumatic heart disease, infective endocarditis, carcinoid syndrome, lupus, complication of a pacemaker|
|Diagnostic method||Suspected based on a diastolic murmur, confirmed by ultrasound of the heart|
|Differential diagnosis||Constrictive pericarditis, tricuspid regurgitation, atrial myxoma|
Tricuspid valve stenosis is a type of valvular heart disease in which there is narrowing of the tricuspid valve opening. Initial symptoms may include tiredness and shortness of breath with exercise. More severe disease may result in leg swelling and liver problems. It is often associated with mitral stenosis.
It occurs most commonly due to rheumatic heart disease. Other causes include infective endocarditis, carcinoid syndrome, lupus, and as a complication of a pacemaker. Rare causes include Ebstein’s anomaly and the medication fenfluramine. Normally, the tricuspid valve opening is about 4 cm2. A decrease in area below 1 cm2 is severe disease. The diagnosis may be suspected based on a diastolic murmur and confirmed by ultrasound of the heart.
Furosemide may be used to help with fluid overload. In severe cases surgery, either in the form of a valvotomy, valve repair, of valve replacement, maybe done. Outcomes depend on the underlying cause.
Signs and symptoms
Causes of tricuspid valve stenosis are:
A mild diastolic murmur can be heard during auscultation caused by the blood flow through the stenotic valve. It is best heard over the left sternal border with rumbling character and tricuspid opening snap with wide-splitting S2. It may increase in intensity with inspiration (Carvallo's sign). The diagnosis will typically be confirmed by an echocardiograph, which will also allow the physician to assess its severity.
Tricuspid valve stenosis itself usually doesn't require treatment. If stenosis is mild, monitoring the condition closely suffices. However, severe stenosis, or damage to other valves in the heart, may require surgical repair or replacement.
The treatment is usually by surgery (tricuspid valve replacement) or percutaneous balloon valvuloplasty. The resultant tricuspid regurgitation from percutaneous treatment is better tolerated than the insufficiency occurring during mitral valvuloplasty.
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