Tricuspid Stenosis Diagnosis and Treatment Guidelines

How to diagnose tricuspid valve stenosis? How to measure tricuspid stenosis? Let’s find out about tricuspid stenosis diagnosis and treatment!

Tricuspid Stenosis Definition

Tricuspid stenosis means: What is tricuspid stenosis? Tricuspid stenosis is when the tricuspid valve in the heart gets narrow.

Tricuspid stenosis is rare. It affects less than 1% of people in developed countries and less than 3% worldwide. Most cases of native valve tricuspid valve stenosis are caused by rheumatism. In the United States, tricuspid stenosis is usually caused by a previous repair or replacement of the tricuspid valve or carcinoid syndrome.

After 8 years, the chance of getting tricuspid stenosis after replacing the tricuspid valve increases significantly. Most of the time, the lesion is accompanied by tricuspid regurgitation. It should be thought of when right heart failure happens because of mitral valve disease or after surgery to repair or replace the tricuspid valve.

tricuspid stenosis diagnosis and treatment guidelines - tricuspid stenosis murmur radiation

Tricuspid Stenosis Causes

What causes tricuspid stenosis? What is the most common cause of tricuspid stenosis? Most of the time, tricuspid valve stenosis is caused by rheumatic fever, which happens when strep throat isn’t treated.

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Tricuspid Stenosis Diagnosis

  • Female predominance.
  • Most likely has a history of rheumatic heart disease. In the United States, the most common causes are carcinoid disease and prosthetic valve degeneration.
  • Echocardiography/Doppler is used to make diagnoses.

Tricuspid Stenosis Symptoms

Signs and symptoms of tricuspid stenosis – What are some symptoms of tricuspid stenosis?

Right heart failure, hepatomegaly, ascites, and dependent edema are signs of tricuspid stenosis. In sinus rhythm, the JVP shows a big wave that is also high. The normal diastolic rumble along the lower left sternal border sounds like mitral stenosis. However, in tricuspid stenosis, the rumble gets louder as the heart pumps blood. In sinus rhythm, you might find a presystolic liver pulsation. Patients who have signs of carcinoid syndrome should think about it.

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Tricuspid Stenosis Diagnostic Evaluation

The ECG shows that the RA is getting bigger if there is no atrial fibrillation. The chest x-ray may show a big heart with a normal-sized PA. In addition, there may be an enlarged superior vena cava and an azygous vein. The normal tricuspid valve area is 10 cm2, so there must be a lot of stenosis for a gradient. Hemodynamically, a mean diastolic pressure gradient of more than 5 mm Hg is considered significant. Still, a gradient of even 2 mm Hg can be considered abnormal. Echocardiography or cardiac catheterization can show this.

The 2017 update to the 2014 AHA/ACC guidelines says that a tricuspid valve area of fewer than 1.0 cm2 and a pressure half-time of more than 190 msec should be considered significant because the gradient can change depending on how fast the heart beats.

Tricuspid Stenosis Treatment and Management Guidelines

Treatment of tricuspid stenosis – What is the best treatment for tricuspid stenosis?

Tricuspid stenosis can get worse over time, causing right-sided heart failure in the end. Therefore, the first step in treatment is to get rid of the fluid buildup, and diuretics are the main treatment.

When there is a lot of swelling in the bowel, torsemide or bumetanide may be better than furosemide because the gut absorbs them better. Aldosterone inhibitors can also help, especially if the liver is swollen or fluid in the abdomen (ascites). Unfortunately, neither surgical nor percutaneous valvuloplasty is very good at relieving tricuspid stenosis because tricuspid regurgitation often happens after the procedure.

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The most common surgery is to replace the tricuspid valve. Mechanical tricuspid valve replacement isn’t done very often because the low flow makes thrombosis more likely, and the mechanical valve can’t be crossed if the right heart needs to be catheterized or a pacemaker put in. So, bioprosthetic valves are usually the best choice.

For rheumatic mitral stenosis or regurgitation, the tricuspid valve is often replaced simultaneously with the mitral valve. Degenerative tricuspid prosthetic valve stenosis has been treated with a percutaneous transcatheter valve replacement (stented valve), and a percutaneous tricuspid valve replacement device is being studied. In severe tricuspid stenosis, there are clear signs that a valve needs to be replaced:

  • Class I indication (LOE C): at the time of surgery for disease of the valve on the left side.
  • Class I indication (LOE C): if symptoms are present.
  • Class IIb indication (LOE C): rarely percutaneous balloon commissurotomy for isolated tricuspid stenosis in high-risk patients without significant tricuspid regurgitation.

A cardiologist should see and keep an eye on all patients with any sign of tricuspid stenosis on an echocardiogram to figure out when they may need treatment.

I hope you understand tricuspid stenosis diagnosis and treatment guidelines.

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