Tricuspid Stenosis

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  • Tricuspid Stenosis
  • Etiology
    • Rheumatic heart disease
    • congenital
    • carcinoid (MCQ)
  • Signs and symptoms
    • Peripheral edema
    • JVD
    • Hepatomegaly, ascites, jaundice
  • Diagnosis
    • Murmur is diastolic, rumbling, low pitched(MCQ)
    • Murmur accentuated with inspiration(MCQ)
    • Best heard over left sternal border between 4th to 5th interspace(MCQ)
    • Echocardiography demonstrates diseased valve.
  • Treatment
    • Surgical repair
  • Clinical Pearls :
    • Female predominance.
    • History of rheumatic heart disease.
    • Carcinoid disease more common etiology in the West(MCQ)
    • Elevated JVP with prominent a wave.(MCQ)
    • Presents with Right heart failureafter tricuspid surgery or in rheumatic disease or carcinoid syndrome.
    • Echocardiography/Doppler is key to diagnosis.
    • Mean valve gradient > 5 mm Hg by echocardiography indicates severe tricuspid stenosis.(MCQ)
    • Tricuspid stenosis¬† should be suspected when “right heart failure” appears in the course of mitral valve disease or in the postoperative period after tricuspid valve repair or replacement.( Important Clinical Vignette for MD Entrance)(MCQ)
    • A giant a wave is seen in the JVP, which is elevated
    • In sinus rhythm, a presystolic liver pulsation may be found.
    • The normal valve area of the tricuspid valve is 10 cm2, so significant stenosis must be present to produce a gradient. (MCQ)
    • Hemodynamically, a mean diastolic pressure gradient of > 5 mm Hg is considered significant, though even a 2 mm Hg gradient can be considered abnormal.
    • Neither surgical nor percutaneous valvuloplasty is effective for tricuspid stenosis, as residual tricuspid regurgitation is common.
    • Tricuspid valve replacement is clearly the preferred surgical approach.(MCQ)
    • Mechanical tricuspid valve replacement is rarely done because the low flow predisposes to thrombosis and because the mechanical valve cannot be crossed should the need arise for right heart catheterization or pacemaker implantation. Therefore, bioprosthetic valves are almost always used. (MCQ)
    • Often tricuspid valve replacement is done in conjunction with mitral valve replacement for mitral stenosis.

 

 


Tricuspid Valve Replacement for Endocarditis. Arie Blitz MD
A short case presentation is followed by an operative video detailing the steps in the performance of a tricuspid valve replacement for extensive endocarditis. In addition to removing the native tricuspid valve and the vegetations, I also remove the patient’s preexisting infected pacemaker leads and replace them with epicardial leads.
Rheumatic tricuspid stenosis and regurgitation
30 Tetralogy of Fallot, VSD, ps, tricuspid
Heart defect: Tetralogy of Fallot (ToF), Tricuspid Regurgitation, pulmonary branch stenosis, pacemaker.
Tricuspid Atresia
The tricuspid valve is a heart valve allowing oxygen-poor blood returning from the body to move from the right atrium to the right ventricle where it is pumped to the lungs. In Tricuspid Atresia, the tricuspid valve fails to form. As a result, blood cannot pass into the right ventricle and into the lungs. This also results in underdeveloped pulmonary arteries and right ventricle. The only way for blood to pass through the heart is through a hole in the wall between the right and left atria.
Tricuspid Atresia
Tricuspid Valve – Function, Anatomy & Location – Human Anatomy | Kenhub
The tricuspid valve which as its name suggests has three separate cusps sits between the right atrium and right ventricle, thus preventing the backflow of atrial blood accumulation when it passes on to the ventricle.
Tricuspid Valve Repair
Tricuspid Valve Repair
Mitral and Tricuspid Valves Repair With Atrial Fibrillation Ablation – Cardiac Surgery Unit UMG