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Tricuspid Stenosis Workup

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

Laboratory Studies

See the list below:

  • Complete blood cell count: If the white blood cell count is elevated, infection should be considered. A disproportionately high hemoglobin (polycythemia) level may be indicative of poor pulmonary blood flow.
  • Complete chemistry profile: The results of this test may help delineate metabolic abnormalities associated with certain inborn errors of metabolism.
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Imaging Studies

See the list below:

  • Chest radiography: Cardiac size may range from normal to enlarged (ie, cardiomegaly). Right atrial enlargement may be prominent. Findings specific to a particular associated congenital heart disease may also be seen.
  • Echocardiography: This test has become the procedure of choice for the diagnosis of valvular disorders. The test results help delineate the structure of the tricuspid valve and any other intracardiac pathology that may contribute to the pathophysiology of the process.[5]
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Other Tests

Electrocardiogram: Arrhythmias are frequent in this patient population. Because of the enlargement of the right atrium, the presence of atrial flutter and/or fibrillation should not be surprising. In sinus rhythm, right atrial enlargement or abnormality (tall P waves on inferior leads) may be noted.

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Procedures

Cardiac catheterization: This may be required prior to surgery in older patients to assess for concomitant coronary artery disease. Right heart catheterization can be used to determine the gradient across the valve and valve area (ie, severity of stenosis) and assess the presence of associated congenital defects (eg, septal defects, intracardiac shunts, anomalous veins) if present. Assessment of aortic and mitral valves via left heart catheterization is useful in patients with rheumatic disease.

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Histologic Findings

Most commonly, stenotic tricuspid valves are secondary to rheumatic fever. These generally demonstrate fibrous tissue proliferation without calcium deposits. The leaflet tissue is composed of dense collagen and elastic fibers, producing major distortions of the normal leaflet layers. Congenitally abnormal valves can show a wide spectrum of incompletely developed leaflets, abnormal chordae tendineae, or dysplastic papillary muscles.

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Contributor Information and Disclosures
Author

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.

Acknowledgements

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.

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. 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].

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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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