Tricuspid stenosis diagnostic study of choice

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vamsikrishna Gunnam M.B.B.S [2]

Overview

Tricuspid stenosis (TS) is characterized by structural changes in the tricuspid valve. The most common cause of tricuspid stenosis (TS) is rheumatic heart disease. Echocardiography is the gold standard test for the diagnosis of tricuspid stenosis which gives tricuspid peak inflow velocity and degree of thickening of tricuspid valve leaflets.

Diagnostic Study of Choice

Study of choice

Echocardiography is the gold standard test for the diagnosis of tricuspid stenosis.

The following result of echocardiography is confirmatory of tricuspid stenosis:^[1]^[2]^[3]
- The degree of thickening of tricuspid valve leaflets
- Calcification of tricuspid valve leaflets
- Limited leaflet mobility of tricuspid valve leaflets
- Reduced separation of the tricuspid valve leaflet tips
- Diastolic doming of the tricuspid valve
- Echocardiography gives the degree of fusion of the commissures and chordae tendineae of the tricuspid valve

Normal echocardiographic appearance of tricuspid valve (*arrow*) and wave pattern. Case courtesy by Soham Shah et al^[4]

Tricuspid stenosis in echocardiography. 2D and color Doppler images in a patient with antiphospholipid antibody syndrome shows thickening of the valve leaflets (*arrow*) and continuous-wave Doppler with a mean pressure gradient of 11 mmHg, which is consistent with severe tricuspid stenosis. Case courtesy by Soham Shah et al^[5]

Staging of Tricuspid stenosis

Based on the valve anatomy, hemodynamics, and consequences tricuspid stenosis can be staged into the following:^[6]^[7]^[8]^[9]^[10]

Stage	Definition	Valve anatomy	Valve hemodynamics	Hemodynamic consequences	Symptoms
C, D	Severe TS	Thickened, distorted, calcified leaflets	T ½ ≥190 ms  Valve area ≤1.0 cm2	Right atrial / Inferior vena cava enlargement	Stage C-No symptoms Stage D-Symptoms variable and dependent on the severity of associated valve disease and degree of obstruction

References

↑ Morgan, Jacob R.; Forker, Alan D.; Coates, J. R.; Myers, W. S. (1971). “Isolated Tricuspid Stenosis”. Circulation. 44 (4): 729–732. doi:10.1161/01.CIR.44.4.729. ISSN 0009-7322.
↑ Finnegan, P; Abrams, L D (1973). “Isolated tricuspid stenosis”. Heart. 35 (11): 1207–1210. doi:10.1136/hrt.35.11.1207. ISSN 1355-6037.
↑ Baumgartner, Helmut; Hung, Judy; Bermejo, Javier; Chambers, John B.; Evangelista, Arturo; Griffin, Brian P.; Iung, Bernard; Otto, Catherine M.; Pellikka, Patricia A.; Quiñones, Miguel (2009). “Echocardiographic Assessment of Valve Stenosis: EAE/ASE Recommendations for Clinical Practice”. Journal of the American Society of Echocardiography. 22 (1): 1–23. doi:10.1016/j.echo.2008.11.029. ISSN 0894-7317.
↑ “Multimodal imaging of the tricuspid valve: normal appearance and pathological entities”.
↑ “Multimodal imaging of the tricuspid valve: normal appearance and pathological entities”.
↑ Nishimura, Rick A.; Otto, Catherine M.; Bonow, Robert O.; Carabello, Blase A.; Erwin, John P.; Guyton, Robert A.; O’Gara, Patrick T.; Ruiz, Carlos E.; Skubas, Nikolaos J.; Sorajja, Paul; Sundt, Thoralf M.; Thomas, James D. (2014). “2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease”. Journal of the American College of Cardiology. 63 (22): e57–e185. doi:10.1016/j.jacc.2014.02.536. ISSN 0735-1097.
↑ Nishimura, Rick A.; Otto, Catherine M.; Bonow, Robert O.; Carabello, Blase A.; Erwin, John P.; Fleisher, Lee A.; Jneid, Hani; Mack, Michael J.; McLeod, Christopher J.; O’Gara, Patrick T.; Rigolin, Vera H.; Sundt, Thoralf M.; Thompson, Annemarie (2017). “2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines”. Circulation. 135 (25). doi:10.1161/CIR.0000000000000503. ISSN 0009-7322.
↑ Nishimura, Rick A.; Otto, Catherine M.; Bonow, Robert O.; Carabello, Blase A.; Erwin, John P.; Guyton, Robert A.; O’Gara, Patrick T.; Ruiz, Carlos E.; Skubas, Nikolaos J.; Sorajja, Paul; Sundt, Thoralf M.; Thomas, James D. (2014). “2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary”. Journal of the American College of Cardiology. 63 (22): 2438–2488. doi:10.1016/j.jacc.2014.02.537. ISSN 0735-1097.
↑ Nishimura, Rick A.; Otto, Catherine M.; Bonow, Robert O.; Carabello, Blase A.; Erwin, John P.; Guyton, Robert A.; O’Gara, Patrick T.; Ruiz, Carlos E.; Skubas, Nikolaos J.; Sorajja, Paul; Sundt, Thoralf M.; Thomas, James D. (2014). “2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary”. Circulation. 129 (23): 2440–2492. doi:10.1161/CIR.0000000000000029. ISSN 0009-7322.
↑ Nishimura, Rick A.; Otto, Catherine M.; Bonow, Robert O.; Carabello, Blase A.; Erwin, John P.; Guyton, Robert A.; O’Gara, Patrick T.; Ruiz, Carlos E.; Skubas, Nikolaos J.; Sorajja, Paul; Sundt, Thoralf M.; Thomas, James D. (2014). “2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease”. Circulation. 129 (23). doi:10.1161/CIR.0000000000000031. ISSN 0009-7322.

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[MorganForker1971-1] Morgan, Jacob R.; Forker, Alan D.; Coates, J. R.; Myers, W. S. (1971). “Isolated Tricuspid Stenosis”. Circulation. 44 (4): 729–732. doi:10.1161/01.CIR.44.4.729. ISSN 0009-7322.

[FinneganAbrams1973-2] Finnegan, P; Abrams, L D (1973). “Isolated tricuspid stenosis”. Heart. 35 (11): 1207–1210. doi:10.1136/hrt.35.11.1207. ISSN 1355-6037.

[BaumgartnerHung2009-3] Baumgartner, Helmut; Hung, Judy; Bermejo, Javier; Chambers, John B.; Evangelista, Arturo; Griffin, Brian P.; Iung, Bernard; Otto, Catherine M.; Pellikka, Patricia A.; Quiñones, Miguel (2009). “Echocardiographic Assessment of Valve Stenosis: EAE/ASE Recommendations for Clinical Practice”. Journal of the American Society of Echocardiography. 22 (1): 1–23. doi:10.1016/j.echo.2008.11.029. ISSN 0894-7317.

[4] “Multimodal imaging of the tricuspid valve: normal appearance and pathological entities”.

[5] “Multimodal imaging of the tricuspid valve: normal appearance and pathological entities”.

[NishimuraOtto2014-6] Nishimura, Rick A.; Otto, Catherine M.; Bonow, Robert O.; Carabello, Blase A.; Erwin, John P.; Guyton, Robert A.; O’Gara, Patrick T.; Ruiz, Carlos E.; Skubas, Nikolaos J.; Sorajja, Paul; Sundt, Thoralf M.; Thomas, James D. (2014). “2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease”. Journal of the American College of Cardiology. 63 (22): e57–e185. doi:10.1016/j.jacc.2014.02.536. ISSN 0735-1097.

[NishimuraOtto2017-7] Nishimura, Rick A.; Otto, Catherine M.; Bonow, Robert O.; Carabello, Blase A.; Erwin, John P.; Fleisher, Lee A.; Jneid, Hani; Mack, Michael J.; McLeod, Christopher J.; O’Gara, Patrick T.; Rigolin, Vera H.; Sundt, Thoralf M.; Thompson, Annemarie (2017). “2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines”. Circulation. 135 (25). doi:10.1161/CIR.0000000000000503. ISSN 0009-7322.

[NishimuraOtto20142-8] Nishimura, Rick A.; Otto, Catherine M.; Bonow, Robert O.; Carabello, Blase A.; Erwin, John P.; Guyton, Robert A.; O’Gara, Patrick T.; Ruiz, Carlos E.; Skubas, Nikolaos J.; Sorajja, Paul; Sundt, Thoralf M.; Thomas, James D. (2014). “2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary”. Journal of the American College of Cardiology. 63 (22): 2438–2488. doi:10.1016/j.jacc.2014.02.537. ISSN 0735-1097.

[NishimuraOtto20144-9] Nishimura, Rick A.; Otto, Catherine M.; Bonow, Robert O.; Carabello, Blase A.; Erwin, John P.; Guyton, Robert A.; O’Gara, Patrick T.; Ruiz, Carlos E.; Skubas, Nikolaos J.; Sorajja, Paul; Sundt, Thoralf M.; Thomas, James D. (2014). “2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary”. Circulation. 129 (23): 2440–2492. doi:10.1161/CIR.0000000000000029. ISSN 0009-7322.

[NishimuraOtto20143-10] Nishimura, Rick A.; Otto, Catherine M.; Bonow, Robert O.; Carabello, Blase A.; Erwin, John P.; Guyton, Robert A.; O’Gara, Patrick T.; Ruiz, Carlos E.; Skubas, Nikolaos J.; Sorajja, Paul; Sundt, Thoralf M.; Thomas, James D. (2014). “2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease”. Circulation. 129 (23). doi:10.1161/CIR.0000000000000031. ISSN 0009-7322.

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