Tricuspid stenosis

Tricuspid valve stenosis

Tricuspid stenosis is a rare condition that may be caused by rheumatic valvular disease, congenital heart disease, Whipple’s disease, or tumors. Rheumatic disease is the most common cause, in which scenario tricuspid stenosis is virtually always accompanied by aortic or mitral disease (most commonly mitral stenosis). Simultaneous tricuspid regurgitation is also common.

Echocardiography

Echocardiography has replaced catheterization for the assessment of tricuspid stenosis. Yet, there is no consensus regarding grading of tricuspid stenosis severity.

Tricuspid stenosis is visually characterized by thickened leaflets, with reduced motion and potentially fused commisures. Continuous Doppler is used to assess the stenosis. Doppler recordings are made during inspiration (velocities across the valve are greater during inspiration). The following findings are indicative of tricuspid stenosis:

• Maximum flow velocity exceeds 1 m/s.
• Pressure half time (PHT) exceeds 190 ms in pronounced stenosis.
• Mean pressure gradient >5.0 mmHg suggests a clinically significant stenosis.

Tricuspid stenosis results in increased right atrial pressure, which subsequently causes right atrial dilation. Vena cava inferior may also dilate secondarily.

Principles of management

• Medical therapies do not alter disease progression. Diuretics may be used for symptom relief.
• Surgical repair or valve replacement is considered when medical therapy is insufficient, or when concomitant valvular disease (e.g mitral stenosis) requires intervention.
• Valve replacement can be performed with biological or mechanical prostheses. The former is preferred due to the lower risk of thrombosis and evidence demonstrating long-term durability (Filsoufi et al).
• Percutaneous interventions lack long-term safety and efficacy data.

References

ESC EACVI Guidelines for Valvular Heart Disease (2018).

Filsoufi F, Anyanwu AC, Salzberg SP, Frankel T, Cohn LH, Adams DH. Long-term outcomes of tricuspid valve replacement in the current era. Ann Thorac Surg 2005;80:845–850.