Tricuspid stenosis

Introduction The most common cause of tricuspid stenosis is still rheumatic fever, often accompanied by insufficiency, mitral and aortic valve damage. Other rare causes are carcinoid tumors, endocardial fibroelastosis and right atrial tumors. When the normal tricuspid orifice area is >7.0cm[sup]2[/sup], <1.5cm[sup]2[/sup], hemodynamic abnormalities occur, resulting in diastolic tricuspid valve transvalvular pressure difference, right Atrial pressure and systemic venous pressure increased, congestion, while right ventricular discharge decreased. Pulmonary manifestations of mitral stenosis may be attenuated by the presence of significant tricuspid stenosis.

Cause

The most common cause is rheumatic heart disease. Tricuspid stenosis alone is rare, often with dysfunction, mitral and aortic valve damage. Pathological changes were similar to mitral stenosis, but the damage was mild. Other rare causes include congenital tricuspid atresia and carcinoid syndrome, cardiac tumors, systemic lupus erythematosus, infective endocarditis, endomyocardial fibrosis, and endocardial fibroelastosis.

an examination

1. Imaging examination

(1) X-ray: the right atrium is enlarged, the superior vena cava is dilated, but the pulmonary artery segment is not prominent.

(2) Echocardiography: Two-dimensional ultrasound can diagnose tricuspid stenosis, and Doppler ultrasound can measure the pressure gradient across the tricuspid valve.

2. Other inspections

Electrocardiogram: right atrial enlargement, P wave amplitude of II, III and aVF leads>0.25mV, no right ventricular hypertrophy.

Differential diagnosis

According to the typical murmur, right atrial enlargement and symptoms and signs of systemic congestion, diagnosis can be made generally. For patients with difficult diagnosis, right heart catheterization should be performed. It should be differentiated from diseases such as right atrial myxoma and constrictive pericarditis. .

Right atrial myxoma: right atrial myxoma is clinically non-specific, mainly characterized by right heart failure, fever and fatigue. If the tumor partially falls off, it can cause pulmonary embolism, which is chest pain, cough and hemoptysis. If the tumor with large activity blocks the right atrioventricular hole, it can cause a sudden drop in cardiac output and cause syncope, but this syncope It can be alleviated with changes in body position.

Constrictive pericarditis: Pericardial thickening, adhesions, and even calcification caused by chronic inflammation of the pericardium, which causes diastole, limited contraction, and decreased heart function, causing symptoms of systemic blood circulation disorders.

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