Tricuspid stenosis

Tricuspid stenosis is more common in females and is mostly caused by rheumatic fever, but isolated rheumatic tricuspid stenosis is extremely rare. Tricuspid stenosis is almost always accompanied by mitral and/or aortic valve disease, and is also combined with tricuspid regurgitation. As a sequelae of rheumatic fever, the pathological changes are similar to those of mitral stenosis, namely fibrous thickening of the valve leaflets, vegetations growing on the edges, and adhesion or fusion of the three leaflets to form a triangular stenotic valve orifice. The pathological process may also extend to the chordae tendineae and papillary muscles. However, the degree and extent of tricuspid valve involvement are milder than those of the mitral valve, subvalvular fusion is rare, and calcium deposition is uncommon. After stenosis develops, blood flow from the right atrium to the right ventricle is obstructed, resulting in right atrial enlargement and elevated pressure. Due to obstruction of venous return from the vena cava, venous pressure remains chronically elevated, manifesting as jugular venous distention, hepatomegaly, ascites, and edema of the extremities. The right ventricle may become atrophic due to reduced blood flow; when combined with mitral valve disease, the right ventricle may become hypertrophied.