Tricuspid Stenosis Follow-up
- Author: Mary C Mancini, MD, PhD, MMM; Chief Editor: Richard A Lange, MD, MBA more...
Further Outpatient Care
Outpatient care consists of routine follow-up care with echocardiography studies to assess valvular function. Check the INR monthly to regulate anticoagulation. In those instances in which the tricuspid stenosis is secondary to some other process (eg, carcinoid, tumor), consider continual surveillance of the underlying disease state.
Further Inpatient Care
Inpatient care consists of treating the underlying precipitating condition. For acute bacterial endocarditis or rheumatic causes, antibiotic therapy is indicated until the acute phase has resolved. Then, valve surgery can be considered, if indicated.
After valve replacement, inpatient care consists of regulating the anticoagulation and treating postoperative arrhythmias until stability has been achieved. After valve replacement, adjust anticoagulation to an international normalized ratio (INR) of 3-4 because of the low-pressure and low-flow state of the right side. Because of the high risk of thrombosis in this low-pressure system, some authors recommend warfarin therapy for bioprosthetic or mechanical valves.
Inpatient & Outpatient Medications
Generally, outpatient medications consist of the anticoagulant warfarin and any antiarrhythmic used to treat atrial fibrillation or flutter, if present. Diuretics may be needed depending on the volume status of the patient.
For those cases in which intravenous drug use or bacterial endocarditis was the precipitating event, emphasize careful dental hygiene. Maximize drug detoxification efforts. Of course, do not forget that routine antibiotic coverage should be administered for prevention of endocarditis.
Complications that can be encountered after tricuspid valve replacement include infection of the prosthetic valve, particularly in those instances when endocarditis was present preoperatively. Tricuspid insufficiency and thromboembolization can also occur.
The prognosis is generally good if therapy is provided for tricuspid stenosis. For those cases in which tumors are the cause of the stenosis, the prognosis is directly related to the prognosis of the underlying disease. In those cases of precipitating infection, if the behavior that caused the initial infection (eg, intravenous drug use) can be modified, prognosis for the patient is good.
Educate patients regarding the adverse effects of anticoagulation. Emphasize instructions regarding dental hygiene and subacute bacterial endocarditis prophylaxis for invasive procedures.
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