eMedicine Specialties > Cardiology > Valvular Heart Disease

Tricuspid Stenosis: Follow-up

Author: Mary C Mancini, MD, PhD, Professor, Department of Surgery, Louisiana State University Health Sciences Center
Contributor Information and Disclosures

Updated: Jul 29, 2008

Follow-up

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.

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.

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.

Deterrence/Prevention

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

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.

Prognosis

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.

Patient Education

Educate patients regarding the adverse effects of anticoagulation. Emphasize instructions regarding dental hygiene and subacute bacterial endocarditis prophylaxis for invasive procedures.

Miscellaneous

Medicolegal Pitfalls

The medicolegal pitfalls in this disease process relate to the complications that can occur with surgical intervention. The operative procedure of valve replacement should be explained carefully, as should the potential postoperative sequelae from the intervention and the subsequent medical treatment that may be needed for control of arrhythmias and anticoagulation.

 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Frank M Sheridan, MD to the development and writing of this article.



More on Tricuspid Stenosis

Overview: Tricuspid Stenosis
Differential Diagnoses & Workup: Tricuspid Stenosis
Treatment & Medication: Tricuspid Stenosis
Follow-up: Tricuspid Stenosis
Multimedia: Tricuspid Stenosis
References
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References

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Further Reading

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Keywords

tricuspid stenosis, tricuspid valve, rheumatic heart disease, mitral stenosis, carcinoid, Ebstein anomaly, tricuspid valve dysfunction, myocardium aberrations, stenotic tricuspid valves, rheumatic fever, carcinoid syndrome, endocarditis, endomyocardial fibrosis, lupus, congenital tricuspid atresia, rheumatic fever, congenital tricuspid stenosis, atrial fibrillation, peripheral edema, ascites, congenital abnormalities, metabolic abnormalities, enzymatic abnormalities, active infective endocarditis, rheumatic tricuspid stenosis, carcinoid heart disease, infective endocarditis, Fabry disease, giant blood cysts, supravalvular obstruction from congenital diaphragms, intracardiac tumor, extracardiac tumor, thrombosis, emboli, large endocarditis vegetations

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Contributor Information and Disclosures

Author

Mary C Mancini, MD, PhD, Professor, Department of Surgery, Louisiana State University Health Sciences Center
Mary C Mancini, MD, PhD is a member of the following medical societies: American Heart Association, American Medical Association, American Thoracic Society, Association for Academic Surgery, Association for Surgical Education, International College of Surgeons, International Society for Heart and Lung Transplantation, New York Academy of Sciences, Phi Beta Kappa, and Southern Thoracic Surgical Association
Disclosure: Nothing to disclose.

Medical Editor

Park W Willis IV, MD, Sarah Graham Distinguished Professor of Medicine and Pediatrics, University of North Carolina at Chapel Hill School of Medicine
Park W Willis IV, MD is a member of the following medical societies: American Society of Echocardiography
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Ronald J Oudiz, MD, Director of Pulmonary Hypertension, Associate Professor, Department of Medicine, Division of Cardiology, Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA
Ronald J Oudiz, MD is a member of the following medical societies: American College of Cardiology, American College of Physicians, and American Heart Association
Disclosure: Actelion Grant/research funds Clinical Trials + honoraria; Encysive Grant/research funds Clinical Trials + honoraria; Gilead Grant/research funds Clinical Trials + honoraria; Pfizer Grant/research funds Clinical Trials + honoraria; United Therapeutics Grant/research funds Clinical Trials + honoraria

CME Editor

Amer Suleman, MD, Consultant in Electrophysiology and Cardiovascular Medicine, Department of Internal Medicine, Division of Cardiology, Medical City Dallas Hospital
Amer Suleman, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Institute of Stress, American Society of Hypertension, Federation of American Societies for Experimental Biology, Royal Society of Medicine, and Society of Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

Chief Editor

Richard A Lange, MD, E Cowles Andrus Professor of Cardiology, Professor of Medicine, Johns Hopkins University School of Medicine
Richard A Lange, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Cardiology, American Heart Association, and Association of Subspecialty Professors
Disclosure: Nothing to disclose.

 
 
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