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Tricuspid Stenosis

By Guy P. Armstrong, MD

Tricuspid stenosis is a narrowing of the tricuspid valve opening that slows blood flow from the right atrium to the right ventricle.

Over many years, the right atrium enlarges because blood flow through the narrowed valve opening is partially blocked, increasing the volume of blood in the atrium. In turn, this increased volume causes an increase in pressure in the veins bringing blood back to the heart from the body (except the lungs). However, the right ventricle shrinks, because the amount of blood entering it from the right atrium is reduced. Tricuspid regurgitation rarely occurs.

Nearly all cases are caused by rheumatic fever, which has become rare in North America, Australasia, and Western Europe. Rarely, the cause is a tumor in the right atrium, a connective tissue disorder, or, even more rarely, a birth defect of the tricuspid valve.

Symptoms are usually mild. They include palpitations (awareness of heartbeats), a fluttering discomfort in the neck, cold skin, and fatigue. Abdominal discomfort may result if the increased pressure in the veins causes the liver to enlarge.

Through a stethoscope, doctors may hear the characteristic murmur of tricuspid stenosis. A chest x-ray shows that the right atrium is enlarged. Echocardiography (see page Echocardiography and Other Ultrasound Procedures) can produce an image of the narrowed valve opening and show the amount of blood passing through the valve, so that the severity of the stenosis can be determined. Electrocardiography (ECG—see page Electrocardiography) shows changes indicating that the right atrium is strained.

Tricuspid stenosis is rarely severe enough to require surgical repair. However, people are encouraged to eat a low-salt diet and are given diuretics and drugs to block the effects of aldosterone (which help decrease pressure in the veins).

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