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Friday, February 18, 2011

TRICUSPID STENOSIS

Tricuspid stenosis is usually rheumatic in origin, and nearly always occurs in association with mitral and aortic valve disease. Isolated rheumatic tricuspid stenosis is very rare. Tricuspid valve disease may also be associated with the carcinoid syndrome.


Clinical features
Usually the symptoms of the associated mitral and aortic valve disease predominate, but tricuspid stenosis causes a raised jugular venous pressure and increases the likelihood of ascites and peripheral oedema.
The main clinical feature is a raised jugular venous pressure with a slow x descent. In sinus rhythm the jugular pulse may show a conspicuous a wave, and there may be presystolic hepatic pulsation, which represents a palpable a wave, There is a mid-diastolic murmur usually best heard at the lower left or right sternal edge; this usually higher pitched than the murmur of mitral stenosis.
Echocardiography is the definitive investigation and shows a fused, rigid tricuspid apparatus. The chest radiograph  shows a large right atrium, but this is non-specific.

Management
In patients who require surgery to other valves, the tricuspid valve is either replaced or subjected to valvotomy at the same time. Balloon valvoplasty is a promising technique for the rare instances of isolated tricuspid stenosis.

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