Tricuspid Valve Stenosis
Terms in this set (24)
Tricuspid Valve stenosis-
A narrowing of tricuspid valve that inhibits the flow of blood from the RA to the RV during diastole.
Who is most likely to acquire Tricuspid stenosis?
- usual patient is 20 to 48 years old
- also have a coexisting and usually dominant mitral stenosis.
Common causes of mitral stenosis-
- Rheumatic fever- most common 65%
- Congenital tricuspid Stenosis
- Carcinoid Heart disease
- Right atrial tumor thrombus
Less common causes of TS-
- Regional Tamponade
- Systemic Lupus
- Intracardiac wires
- Prosthetic heart valve
Patient symptoms and Physical Examination:
- signs and symptoms of MS-
- Right upper quadrant Pain
- flutter feeling in the neck
- jugular venous distention
- Peripheral edema without pulmonary congestion
- peripheral edema
- Jugular venous distention
- Sounds like mitral stenosis
- Opening snap- (may occur later than MV opening snap)
- Diastolic rumble heard best at apex
- Both of these sounds may be accentuated with inspiration as it increases flow to the right heart.
- Physician may describe a pre systolic click with atrial contraction.
- biatrial enlargement
- RV hypertrophy in the event of coexisting MS.
Complications of TS:
- decreased cardiac output
- Increase risk of endocarditis
Choices of treatment:
- there are two types of treatment available
- surgical treatment
- these choices are generally made before the active disease has begun, but they include:
- Prophylaxis to treat or prevent rheumatic fever
- Prophylaxis to prevent endocarditis
- rarely does the TV stenosis become so severe that these choices are required.
- surgical or Balloon commissurotomy
- Valve repair or replacement
2D- findings that are noted at the valve itself:
- thickened leaflet particularly at the tips and may include the chordae tendineae
- Restricted of limited motion of valve leaflets
- Diastolic doming
2D- findings that may also be seen as a result of what is going on:
- Dilated IVC ( >2.3 cm)
- Dilated Hepatic veins (>1.1cm)
- Atrial septal bulge to the left
- stenosis may begin at the ________ _________ only with the mid portion of the leaflet remaining pliable.
Leaflets may only be ____________ ____________ in appearance.
______________ may not be deformed of involved.
Complete calcification only occurs ______ in the disease process if ever.
- Thickened leaflets
- Anterior motion of the posterior leaflet if visualized
- E to F slope is decreased
- Reduced excursion ( D to E )
- Evidence of PHTN of "flying W" ( absent A wave and mid systolic closure of the PV )
Color doppler findings:
- turbulent flow across the valve during diastole with a primarily mosaic jet
- Tricuspid Valve regurgitation demonstrates a primarily blue mosaic jet in RA during systole.
PW doppler findings:
- Increased Tricuspid Valve E velocity
- Increase in the deceleration time of diastolic flow
- Tricuspid valve regurgitation
CW doppler findings:
- Tricuspid Valve regurgitation maximum velocity
Calculations and determinations:
- Tricuspid Valve area by PHT
- severity of stenosis
- severity of regurgitation
Tricuspid Stenosis Measurements:
- Normal valve area: 7 to 9 cm^2
- Severe- < 2.0 cm^2