Tricuspid Stenosis Treatment & Management

  • Author: Mary C Mancini, MD, PhD; Chief Editor: Richard A Lange, MD   more...
 
Updated: Jul 1, 2011
 

Medical Care

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.
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Surgical Care

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.[6]
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Consultations

  • 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.
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Diet

  • 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.
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Activity

  • 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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Contributor Information and Disclosures
Author

Mary C Mancini, MD, PhD  Professor and Chief of Cardiothoracic Surgery, Department of Surgery, Louisiana State University School of Medicine in Shreveport

Mary C Mancini, MD, PhD is a member of the following medical societies: American Association for Thoracic Surgery, American College of Surgeons, American Surgical Association, Phi Beta Kappa, Society of Thoracic Surgeons, and Southern Surgical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Ronald J Oudiz, MD, FACP, FACC, FCCP  Professor of Medicine, University of California, Los Angeles, David Geffen School of Medicine; Director, Liu Center for Pulmonary Hypertension, Division of Cardiology, LA Biomedical Research Institute at Harbor-UCLA Medical Center

Ronald J Oudiz, MD, FACP, FACC, FCCP is a member of the following medical societies: American College of Cardiology, American College of Chest Physicians, American College of Physicians, American Heart Association, and American Thoracic Society

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; Lilly Grant/research funds Clinical Trials + honoraria; LungRx Clinical Trials + honoraria; Bayer Grant/research funds Consulting

Amer Suleman, MD  Private Practice

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  Professor and Executive Vice Chairman, Department of Medicine, Director, Office of Educational Programs, University of Texas Health Science Center at San Antonio

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.

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.

References

  1. Lev M, Liberthson RR, Joseph RH, Seten CE, Eckner FA, Kunske RD, et al. The pathologic anatomy of Ebstein's disease. Arch Pathol. Oct 1970;90(4):334-43. [Medline].

  2. Waller BF. Morphological aspects of valvular heart disease: Part I. Curr Probl Cardiol. Oct 1984;9(7):1-66. [Medline].

  3. Waller BF. Morphological aspects of valvular heart disease: Part II. Curr Probl Cardiol. Nov 1984;9(8):1-74. [Medline].

  4. Acikel M, Erol MK, Yekeler I, Ozyazicioglu A. A case of free-floating ball thrombus in right atrium with tricuspid stenosis. Int J Cardiol. Apr 2004;94(2-3):329-30. [Medline].

  5. Faletra F, La Marchesina U, Bragato R, De Chiara F. Three dimensional transthoracic echocardiography images of tricuspid stenosis. Heart. Apr 2005;91(4):499. [Medline].

  6. Roberts PA, Boudjemline Y, Cheatham JP, et al. Percutaneous Tricuspid Valve Replacement in Congenital and Acquired Heart Disease. JACC. 2011;58:117-22.

  7. Arnett EN, Roberts WC. Pathology of active infective endocarditis: a necropsy analysis of 192 patients. Thorac Cardiovasc Surg. Dec 1982;30(6):327-35. [Medline].

  8. Block PC, Bonhoeffer P. Percutaneous approaches to valvular heart disease. Curr Cardiol Rep. Mar 2005;7(2):108-13. [Medline].

  9. DiSesa VJ, Mills RM Jr, Collins JJ Jr. Surgical management of carcinoid heart disease. Chest. Nov 1985;88(5):789-91. [Medline].

  10. Kratz JM, Crawford FA Jr, Stroud MR, et al. Trends and results in tricuspid valve surgery. Chest. Dec 1985;88(6):837-40. [Medline].

  11. Miller BR, Vohr FH, Christian FV, Singh AK. Cardiac valvular replacement in carcinoid heart disease. Am J Med. Nov 1983;75(5):896-8. [Medline].

  12. Morgan JR, Forker AD, Coates JR, Myers WS. Isolated tricuspid stenosis. Circulation. Oct 1971;44(4):729-32. [Medline].

  13. Mukhopadhyay S, Suryavanshi S, Yusuf J, et al. Isolated thrombus producing tricuspid stenosis: an unusual presentation in primary antiphospholipid syndrome. Indian Heart J. Jan-Feb 2004;56(1):61-3. [Medline].

  14. Sakata Y, Koibuchi N, Xiang F, et al. The spectrum of cardiovascular anomalies in CHF1/Hey2 deficient mice reveals roles in endocardial cushion, myocardial and vascular maturation. J Mol Cell Cardiol. Oct 18 2005;[Medline].

  15. Sharieff S, Saghir T, Shah-e-Zaman K, et al. Concurrent percutaneous valvuloplasty of mitral and tricuspid valve stenoses. J Invasive Cardiol. Jun 2005;17(6):340-2. [Medline].

 
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A representation of a stenotic tricuspid valve. This image demonstrates fusion of the commissures (shown as dotted lines).
 
 
 
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