Tricuspid Stenosis

Tricuspid Stenosis

Tricuspid stenosis (TS) is much rarer, compared to mitral stenosis. Rheumatic TS is almost invariably associated with mitral stenosis. Carcinoid heart disease is another important cause of TS. Tricuspid stenosis can also occur as a part of Ebstein’s anomaly of the tricuspid valve.

TS leads to right atrial dilatatation and a prominent a wave in the jugular venous pulse. Right atrial dilatation can stretch open the foramen ovale and lead to right to left shunt. Since tricuspid valve is the largest of the cardiac valves, even a gradient as low as 2 mm Hg can indicate significant TS.

ECG shows right atrial overload in the form of peaked P waves in lead II and a tall initial peak in V1. X-ray chest may show the right atrial enlargement as a rightward shift of the right heart border or an increase in the vertical height of the right heart border. TS produces a mid diastolic murmur in the tricuspid area which increases with inspiration, like all right sided murmurs. Severe TS produces presystolic hepatic pulsations due to vigorous atrial contraction against a stenotic tricuspid valve.

TS can be treated by balloon tricuspid valvotomy with good results.