Stenosis of the tricuspid valve: causes, symptoms, diagnosis, treatment

Stenosis of the tricuspid valve is a narrowing of the tricuspid valve opening, which impedes the flow of blood from the right atrium to the right ventricle. Almost all cases are the result of rheumatic fever. Symptoms of stenosis of the tricuspid valve include a fluttering discomfort in the neck, fatigue, cold skin and discomfort in the upper right quadrant of the abdomen. You can see pulsation of the jugular veins, you often hear presystolic murmur in the fourth intercostal space to the left near the edge of the sternum, which is strengthened by inhalation. Diagnosis is established by echocardiography. Stenosis of the tricuspid valve is usually a benign condition, therefore, no specific therapy is prescribed, but for patients who have symptomatology, surgical treatment can be effective.

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What causes stenosis of the tricuspid valve?

Stenosis of the tricuspid valve is almost always a consequence of rheumatic fever. In most cases, there is also TP, as in mitral damage (usually with mitral stenosis). Rare causes of stenosis of the tricuspid valve include SLE, carcinoid syndrome, myxoma of the right atrium (PP), congenital pathology, primary or metastatic tumor and limited constrictive pericarditis. The right atrium becomes hypertrophic and distended, heart failure develops as a complication of the lesion of the right heart, but without right ventricular dysfunction. The latter remains insufficiently filled and small in size. Sometimes there is atrial fibrillation.

Symptoms of stenosis of the tricuspid valve

Symptoms of severe tricuspid stenosis include pulsatile neck discomfort (due to the giant jugular pulse wave), fatigue, cold skin (due to low cardiac output) and discomfort in the upper right quadrant of the abdomen (due to enlarged liver).

The first visible sign is a giant fine-toothed wave, with a gradual decrease in y on the jugular veins. With the development of atrial fibrillation, the wave v becomes noticeable in the jugular pulse. You can detect the swelling of the jugular veins, which increases with inspiration (Kussmaul's symptom). The face can acquire a dark color, possibly the veins of the scalp, when the patient lies (the symptom of the "tide"). Immediately before the systole, hepatic pulsation can be felt. Often there are peripheral edema.

With auscultation, the stenosis of the tricuspid valve can give a soft tone of the valve opening. Sometimes you hear a click in the middle of the diastole. For tricuspid stenosis, a short, scraping, progressive-decreasing presystolic noise is characteristic, which is heard best through a stethoscope with a diaphragm in the fourth or fifth intercostal space to the right of the sternum or in the epigastric region, when the patient sits forward (approaching the heart to the chest wall) or lies on right side (increasing flow through the valve). The noise grows louder and longer with maneuvers that increase the venous influx (for example, physical exercises, inhalation, lifting of the foot, Muller's test), and softer and shorter at receptions reducing the venous influx (vertical position, Valsalva test).

Symptoms of stenosis of the tricuspid valve are often combined with symptoms of mitral stenosis and are therefore masked by manifestations of the latter. Noises can be distinguished clinically.

Diagnosis of tricuspid stenosis

Preliminary diagnosis is based on anamnesis, physical examination and is confirmed by Doppler echocardiography, in which the pressure gradient in the tricuspid valve region is> 2 mm Hg. Art. With a high-speed turbulent flow and slower filling of the atrium. Two-dimensional echocardiography can show an expansion of the right atrium. ECG and chest radiography are often performed. ECG data can reflect the expansion of the right atrium in a disproportion in relation to right ventricular hypertrophy and a high, pointed P tooth in the lower leads and V1. Radiography of the chest can demonstrate an enlarged upper vena cava and an expansion of the right atrium, defined as an enlarged right border of the heart. Due to stagnation in the liver, an increase in the activity of hepatic enzymes is possible.

Distinction of noise in stenosis of tricuspid and mitral valves

Characteristic	Tricuspid	Mitral
Character	Scraping	Rumbling, high-frequency
Duration	Short	Long
Time of appearance	Begins in early diastole and does not grow until S	It grows during diastole
Causes of noise amplification	Breath	Exercise stress
The place of best listening	At the bottom of the sternum, right and left	The top of the heart, when the patient lies on the left side

With stenosis of the tricuspid valve, cardiac catheterization is rarely prescribed. If catheterization is prescribed (for example, to assess the anatomy of the coronary vessels), the study may reveal increased pressure in the PP with a slow decrease in early diastole and a diastolic pressure gradient in the tricuspid valve region.

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Treating tricuspid stenosis

Indications for treatment are not sufficient. In all patients with clinical manifestations, treatment should include a diet low in table salt, diuretics and ACE inhibitors. Patients with a valve gradient of pressure of about 3 mm Hg. Art. And a valve area <1.5 cm ² can be subjected to surgical treatment. Methods of treatment include balloon valvulotomy and (in patients with unsatisfactory results that can transfer surgical intervention) open valve plastic or its prosthesis. Comparative results have not been studied. Correction of stenosis of tricuspid valve without treatment of coexisting mitral stenosis can provoke left ventricular heart failure.