Tricuspid Stenosis Workup

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

Laboratory Studies

  • 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

  • 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  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

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  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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