Definition

Tricuspid stenosis is characterised by a constriction or narrowing of the tricuspid valve. This affects the blood flow between the right atrium and right ventricle (see figure 1).

Figure 1

The narrowing causes less blood to flow through the tricuspid valve.

Aetiology

  • Rheumatic fever: Inflammation caused by rheumatic fever leads to scarring and thickening of the valve, thereby restricting blood flow through the valve. 

  • Pulmonary hypertension: causes the valve to thicken and scar. 

  • Mitral stenosis

  • Atrial septal defect

  • Infectious endocarditis

Pathophysiology

The right atrium attempts to compensate for a constricted tricuspid valve by increasing blood flow through its valve. This, however, causes an increase in atrial pressure and a blood back-up in the liver and other organs. As a result, peripheral edoema, abdominal enlargement, shortness of breath, and fatigue are common symptoms of tricuspid stenosis.

In order to pump more blood through the tricuspid valve, the right ventricle is also overloaded as the disease progresses. This results in ventricular thickening and decreased efficiency. This could ultimately result in heart failure. Additionally, it is essential to understand that blood pooling increases the risk of blood clots.

Risk factors

  • Rheumatic fever

  • Congenital heart defect 

  • Infective endocarditis

Sign and symptoms

  • Peripheral edoema 

  • Abdominal swelling 

  • Shortness of breath 

  • Ankle swelling

  • Tachycardia 

  • Chest pain 

  • Heart murmur: During mid-diastole, the murmur of tricuspid stenosis is audible at the lower left sternal border.e

Investigations

  • Echocardiogram 

  • Cardiac catheterization: A catheter is inserted into a blood vessel and guided into the heart during cardiac catheterization. This enables the clinician to measure the pressure in the right atrium and ventricle, as well as visually inspect the tricuspid valve.

  • MRI 

  • CXR 

  • ECG

Management

  • If mild/moderate: no treatment, treat underlying condition e.g HF, HTN etc. 

  • Surgery : repair or replacement of tricuspid valve. Transcatheter tricuspid valve replacement (TTVR) is a common procedure done through a catheter.

 
 
 

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