Q. What do you know about Tricuspid stenosis?

It is rare disease, with rheumatic etiology seen in 90 per cent of cases. In patients with rheumatic mitral stenosis only 3-5 per cent have concomitant tricuspid stenosis. Milder degrees of organic tricuspid valve involvement, up to 15-30 per cent are noted in autopsy series and in echocardiogram. Also tricuspid stenosis progresses much more slowly and develops clinical features on an average a decade later than mitral stenosis. Unusual causes of tricuspid stenosis include carcinoid disease, congenital anomalies, infective endocarditis, Whipple's Disease and right atrial myxoma.

Pathophysiology

Obstruction to the tricuspid valve results in increased right atrial pressures, systemic venous congestion with right heart failure and low cardiac output state.

Clinical Findings

Since tricuspid stenosis, which is most often rheumatic, coexist with mitral stenosis, it is difficult to differentiate symptoms of one disease from other. In general, patient will have complaints of dyspnoea, fatigue and peripheral edema. Jugular venous pressure is characterized by prominent "a" wave and slow "y" descent in sinus rhythm. Absence of ‘y' trough is noted in atrial fibrillation. Diastolic murmur generated across tricuspid valve has a distinct crescendo-decrescendo shape-a finding accentuated in 1^o heart block. It is typically located at lower left sternal border and increases with inspiration. Tricuspid opening snap is difficult to appreciate.