Tricuspid stenosisTricuspid stenosis is the hardening and narrowing of the tricuspid valve, which regulates blood flow between the right atrium and the right ventricle. When this valve is narrowed, the volume of blood flow is reduced.
The tricuspid valve is located between the right atrium and the right ventricle of the heart. It is the largest of the four valves in the heart. When the tricuspid valve is narrowed or stiffened, it decreases the amount of blood that can flow through it. This decrease raises the pressure in the right atrium and causes the atrium to enlarge. It also causes the right ventricle to shrink, and lowers the cardiac output.
Tricuspid valve stenosis is most often the result of rheumatic fever. On rare occasions, it is caused by a tumor or disease of the connective tissue. The rarest cause is a birth defect. A person with tricuspid valve stenosis may experience generalized weakness and fatigue. Many people have palpitations and can feel fluttering in their neck. Over time, there may be pain in the upper right abdomen, due to increased congestion and enlargement of the liver.
The most frequent acquired cause is rheumatic heart disease. Rare acquired causes are carcinoid syndrome cardiac involvement, primary and secondary cardiac or paracardiac tumours, and right atrial thrombus. Rheumatic TS is uncommon and almost always occurs in association with mitral valve disease. Chest X-ray shows cardiomegaly with right atrial enlargement. Signs of associated mitral valve disease are usually evident such as left atrial enlargement. Echocardiography demonstrates diastolic doming of the tricuspid leaflets and poor diastolic separation of the tips of the leaflets. Doppler echocardiography demonstrates increased diastolic flow velocity across the valve and can be used to estimate the peak gradient by applying the modified Bernoulli equation.
Your doctor may not notice tricuspid stenosis during your physical exam. However, it may be suspected if there is pressure in the veins of your neck or if you have mitral valve stenosis with milder-than-normal symptoms.
Treatment for tricuspid stenosis is generally dictated by other valvular problems. Because most people who have tricuspid stenosis also have mitral valve stenosis and require surgical treatment for this condition, the most common treatment of tricuspid stenosis is surgery. Surgical options include valve repair or replacement. The doctor may try to eliminate the problems associated with stenosis by manipulating the leaflets to make them less rigid, and then stitching two of the three leaflets together to keep them from becoming too weak (valve repair). Alternatively, the surgeon may choose to completely replace your original valve.
Rheumatic fever, the usual cause of tricuspid valve stenosis, has almost disappeared in North America and western Europe. Therefore, the number of people who acquired this condition in childhood will decline over time.