Tricuspid Stenosis Treatment & Management
- Author: Mary C Mancini, MD, PhD, MMM; Chief Editor: Richard A Lange, MD, MBA more...
In the treatment of tricuspid stenosis, medical care consists of assessment and treatment of the underlying cause of the valvular pathology.
- Treat bacterial endocarditis with the appropriate antibiotics as determined by the sensitivity of the organisms cultured.
- Medically address cardiac arrhythmias depending on their characterization.
- Decreasing right atrial volume overload with diuresis and salt restriction helps decrease symptoms and improve hepatic function.
The American Heart Association/American College of Cardiology and the European Society of Cardiology have published guidelines on the management of patients with valvular heart disease.[6, 7]
Tricuspid stenosis remains a surgical disease and requires either commissurotomy or replacement of the valve if right heart failure or low cardiac output has resulted. Surgery is rarely performed solely on the tricuspid valve; it is usually performed in combination with mitral and/or aortic valve disease repair.
- With tricuspid valve replacement, the risk of thrombosis is significant and many surgeons advise warfarin therapy for either mechanical or bioprosthetic valve placement.
- Percutaneous balloon valvuloplasty has been used successfully, as long as concomitant regurgitation is not significant.
- The therapy chosen depends on the structure of the valve and the degree of deformity encountered.
- When possible, excise intracavitary pathology, whether it be tumors or other structural abnormalities.
- Redundant portions of the dilated right atrium can be excised during the same procedure for restoring the atrium back to normal size.
- In selected patients with prior tricuspid valve surgery and significant stenosis of a bioprosthetic tricuspid valve or a right atrium to right ventricle (RA-to–RV) conduit, percutaneous tricuspid valve replacement may be an option.
- Transcatheter valve-in-valve implantation with either the Melody or Edwards SAPIEN valve may be a potential procedure for patients with significant tricuspid stenosis, significant tricuspid regurgitation, or a mixed lesion and a failing bioprosthesis.
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- Consultation with infectious disease specialists may be appropriate if the stenosis is secondary to an infectious process.
- An endocrinologist may be of assistance if carcinoid syndrome or an inborn error of metabolism is the cause of the pathology.
See the list below:
- No specific dietary restrictions are necessary before therapy.
- Fluid and sodium restriction is prudent if signs of venous congestion are present.
- If a valve replacement is undertaken and the patient must be anticoagulated, dietary instructions must be provided regarding those foods that interfere with anticoagulation and are rich in vitamin K.
See the list below:
- Activity is usually self-limited by the patient because of easy fatigability secondary to oxygen deprivation.
- Once the pathology has been corrected, no activity restrictions are necessary.
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Waller BF. Morphological aspects of valvular heart disease: Part II. Curr Probl Cardiol. 1984 Nov. 9(8):1-74. [Medline].
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[Guideline] Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Guyton RA, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014 Jun 10. 63(22):e57-185. [Medline].
[Guideline] Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Barón-Esquivias G, Baumgartner H, et al. Guidelines on the management of valvular heart disease (version 2012). Eur Heart J. 2012 Oct. 33(19):2451-96. [Medline].
Badheka AO, Shah N, Ghatak A, Patel NJ, Chothani A, Mehta K, et al. Balloon Mitral Valvuloplasty in United States: A 13 year perspective. Am J Med. 2014 May 20. [Medline].
Roberts PA, Boudjemline Y, Cheatham JP, et al. Percutaneous Tricuspid Valve Replacement in Congenital and Acquired Heart Disease. JACC. 2011. 58:117-22.
Godart F, Baruteau AE, Petit J, et al. Transcatheter tricuspid valve implantation: A multicentre French study. Arch Cardiovasc Dis. 2014 Nov. 107(11):583-91. [Medline].