Organic tricuspid stenosis is an unusual but important finding.
The clinical signs can easily be masked by those of the mitral
valve disease with which it is almost invariably associated. Because
of the low pressures in the right side of the heart, significant
tricuspid stenosis can produce transvalvular pressure gradients
of 1mmHg or less, which are hard to detect by cardiac catheterization,
even when suspected in advance.
 |
| Fig. 16 |
Echocardiography, in contrast, is a very sensitive method for
detecting tricuspid stenosis, and examination of the tricuspid
valve should always be included in all patients, particularly
in patients with rheumatic aortic or mitral valve disease. (Fig.
16) shows an M-mode scan from tricuspid to mitral valve in
a patient with both mitral and tricuspid stenosis. Similar changes
are evident in both valves, namely reduced mobility, leaflet thickening,
and reduced or reversed motion of the posterior leaflet.
Clear two-dimensional visualization of the stenotic tricuspid
orifice is not as easy as with the mitral valve. This is due to
the lack of an appropriate window by which to access the plane
of the open tricuspid valve. In fact, it is a rare patient where
the severity of tricuspid stenosis may be planimetered. As with
mitral stenosis, the severity of tricuspid stenosis may be estimated
by Doppler methods and has been shown to be quite helpful in this
regard.
 |
| Fig. 17 |
The apical four-chamber view, however, will reveal tethering of
the tricuspid leaflet tips in patients with tricuspid stenosis,
(Fig.
17) shows fusion of both the tricuspid and mitral valve leaflet
tips during diastole in tricuspid and mitral stenosis.
2004
