Tricuspid stenosis
Tricuspid stenosis is obstruction of right atrial emptying from a narrowed tricuspid valve, almost always rheumatic and usually accompanying mitral stenosis. It causes right-sided congestion with a prominent jugular a wave and a diastolic murmur that increases with inspiration; severe symptomatic disease is treated with valve repair or replacement.
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What this article covers
- Overview
Definition: tricuspid stenosis is obstruction to right atrial emptying caused by narrowing of the tricuspid valve, raising right atrial pressure.
- Epidemiology
Uncommon, almost always rheumatic and rarely isolated.
- Risk factors
Rheumatic heart disease (the dominant cause).
- Pathophysiology
Fixed right-sided obstruction: commissural fusion and leaflet thickening impede right atrial emptying, requiring a raised right atrial pressure.
- Clinical features
Fatigue and low-output symptoms. Right-sided congestion: peripheral edema, ascites, and hepatomegaly.
- Differential diagnosis
Mitral stenosis: an apical diastolic rumble, usually coexisting, distinguished from tricuspid stenosis by an apical (rather than left sternal border) murmur that softens with inspiration (Mitral stenosis).
- Diagnosis
Establish and grade with echocardiography measuring the transtricuspid gradient: the diagnostic basis is echocardiography showing rheumatic leaflet thickening and doming with a raised mean diastolic…
- Management
First-line, relieve congestion medically with sodium restriction and diuresis to reduce systemic venous congestion: Furosemide 20 to 40 mg PO or IV daily, titrated.
- Complications
Refractory right heart failure, ascites, and cardiac cirrhosis.
- Prognosis
Depends on coexisting mitral and pulmonary disease.
- Prevention
Secondary rheumatic fever prophylaxis with benzathine penicillin G 1.2 million units IM every 4 weeks, continued for at least 10 years or until age 40.
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Related articles
- Tricuspid regurgitation
Tricuspid regurgitation is systolic backflow from the right ventricle into the right atrium, most often secondary (functional) from right ventricular or annular dilation and pulmonary hypertension. It causes right-sided congestion with a prominent jugular v wave and a systolic murmur that increases on inspiration; management targets the underlying cause and, in selected severe disease, valve intervention.
- Mitral stenosis
Mitral stenosis is obstruction of left atrial emptying from a narrowed mitral valve, overwhelmingly rheumatic in origin. It causes left atrial hypertension, atrial fibrillation, and pulmonary congestion, with a diastolic rumble and opening snap; severe symptomatic disease is treated with percutaneous balloon valvuloplasty or valve surgery.
- Rheumatic heart disease
Rheumatic heart disease is chronic valvular damage following acute rheumatic fever, an autoimmune sequela of group A streptococcal pharyngitis. It predominantly scars the mitral and aortic valves, causing stenosis and regurgitation years later; management is secondary antibiotic prophylaxis, treatment of valve lesions, and prevention of recurrent rheumatic fever.
- Constrictive pericarditis
Constrictive pericarditis is a rigid, often calcified pericardium that impairs diastolic filling, causing predominantly right-sided heart failure. It follows pericardial injury (post-surgical, tuberculous, radiation, or idiopathic), is distinguished from restrictive cardiomyopathy by hemodynamic and imaging features, and definitive treatment is pericardiectomy.
- Restrictive cardiomyopathy
Restrictive cardiomyopathy is impaired ventricular filling from a stiff, noncompliant myocardium with preserved (or near-preserved) systolic function and non-dilated ventricles, most often from infiltration such as amyloidosis. It presents as predominantly right-sided heart failure, and diagnosis centers on echocardiography and cardiac MRI plus a search for the underlying cause, distinguishing it from constrictive pericarditis; management treats the underlying cause with cautious diuresis.