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Tricuspid Stenosis Treatment & Management

  • Author: Mary C Mancini, MD, PhD, MMM; Chief Editor: Richard A Lange, MD, MBA  more...
Updated: Dec 18, 2014

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.

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]


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.[8]
  • 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.[9]
  • 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.[10]


See the list below:

  • 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.
Contributor Information and Disclosures

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

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

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

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 Thoracic Society, American College of Physicians, American Heart Association

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Actelion, Bayer, Gilead, Lung Biotechnology, United Therapeutics<br/>Received research grant from: Actelion, Bayer, Gilead, Ikaria, Lung Biotechnology, Pfizer, Reata, United Therapeutics<br/>Received income in an amount equal to or greater than $250 from: Actelion, Bayer, Gilead, Lung Biotechnology, Medtronic, Reata, United Therapeutics.

Chief Editor

Richard A Lange, MD, MBA President, Texas Tech University Health Sciences Center, Dean, Paul L Foster School of Medicine

Richard A Lange, MD, MBA is a member of the following medical societies: Alpha Omega Alpha, American College of Cardiology, American Heart Association, Association of Subspecialty Professors

Disclosure: Nothing to disclose.

Additional Contributors

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.


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

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

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

  3. Waller BF. Morphological aspects of valvular heart disease: Part II. Curr Probl Cardiol. 1984 Nov. 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. 2004 Apr. 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. 2005 Apr. 91(4):499. [Medline].

  6. [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].

  7. [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].

  8. 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].

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

  10. 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].

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