Internal Medicine

0521779407-20 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:22

Tricuspid Valve Stenosis (TS) 1451

tests

Note: findings below for isolated tricuspid valve stenosis without pathol-

ogy on other cardiac valves

ECG

■Right atrial enlargement

■Atrial fibrillation

Chest X-Ray

■Cardiomegaly with right atrial enlargement

■Dilated superior vena cava and azygos vein

■No pulmonary congestion

Echo/Doppler

■Thickening and immobility of tricuspid valve leaflets

■Diastolic gradient across tricuspid valve

■Enlarged right atrium

■Normal right ventricle (isolated TS)

➣(Note, rheumatic in etiology – pathology usually present on other

heart valves, such as mitral valve)

Cardiac Catheterization

■Right ventricular/right atrial diastolic gradient; mean gradient of

5 mm Hg associated with signs of systemic venous congestion

■Cardiac output reduced at baseline or decreases with exercise

differential diagnosis

■Mitral stenosis

■Right atrial tumors

■Tricuspid atresia

management

Medical

■Antibiotic prophylaxis

■Diuretics

specific therapy

■Tricuspid commissurotomy during surgery for other heart valve

➣pathology

■Percutaneous balloon tricuspid valvotomy for isolated TS