Tricuspid Stenosis

Abnormal narrowing of the tricuspid valve orifice.

Tricuspid stenosis is rare and is most often due to multivalvular rheumatic heart disease or the carcinoid syndrome. Patients with isolated tricuspid stenosis have signs of right-sided heart failure with elevated cervical venous pressure, hepatomegaly, edema, and ascites; dyspnea and orthopnea are often absent. Commonly, exercise tolerance decreases because of low cardiac output. Hepatomegaly is present without other signs of left-sided heart failure.

The lower left sternal border diastolic rumble increases during inspiration. A low-pitched murmur is heard in the third or fourth intercostal space at the left sternal border; it frequently becomes louder with inspiration. A prominent A wave with poor or absent Y descent is seen in the jugular venous pulse. The diagnosis is made by finding the characteristic murmur and jugular venous pulse.

Medical therapy is indicated for mild disease. Although surgical repair is rarely required, balloon valvotomy is the treatment of choice for patients with signs of right-sided heart failure or with markedly decreased exercise tolerance due to inability to increase cardiac output. If the valve is calcified (a rare finding), valve replacement is necessary.