Introduction
Tricuspid stenosis is a rare heart disease involving the heart valves, seen in only one percent of the cases. The tricuspids are leaf-like structures where the narrowing of the valve may occur due to multiple reasons. The reason for the formation of stenosis is the congestion of the blood vessels. Tricuspid stenosis is seen as an elevation between the right atrium and left ventricle (heart chambers). Tricuspid stenosis is rarely seen as an individual disease. It is always associated with other heart diseases, commonly in patients with rheumatic heart disease (an inflammatory disease of the heart).
What Are the Types of Tricuspid Stenosis and Its Causes?
Tricuspid stenosis can be broadly classified into three types, and they are:
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Acquired tricuspid stenosis: It is one of the most common types of tricuspid stenosis. It is often seen as associated with mitral stenosis (a clinical condition characterized by the clogging of the mitral valve of the heart). As the name indicates, acquired adjoining diseases like systemic lupus erythematosus, antiphospholipid antibody syndrome, and noncancerous tumors like atrial myxomas, etc. cause stenosis.
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Congenital Tricuspid Stenosis: The condition occurs due to a developmental defect. The development defects associated with this condition mainly occur due to metabolic and enzymatic abnormalities like Ebstein's anomaly and Fabrys and Whipple's disease.
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Iatrogenic Tricuspid Stenosis: This type of tricuspid stenosis occurs due to physician-induced reasons like using defibrillators or post-surgeries like tricuspid valve repair done to treat valve regurgitation.
How Does a Tricuspid Stenosis Take Place?
The main cause of tricuspid stenosis is increased pressure in the right atrium and congestion of the right-sided heart. Tricuspid stenosis occurs when there are elevated ratio levels between the right and the left atrium. The tricuspid valves of the heart are made up of an outer endothelial layer lined by the extracellular matrix. Irrespective of the cause being hereditary, environmental, or acquired, there is a disruption in the extracellular matrix altering the valve mechanics that interfere with the functions of the valve leaflet causing damage to the valve.
Tricuspid Stenosis is seen in over 2.4 percent of cases as an organic valve disease. It is commonly seen affecting young women. The disease is below one percent of all heart diseases affecting the valve and is associated with 90 percent of rheumatic heart diseases.
How Is Tricuspid Stenosis Observed Clinically?
The clinical symptoms of tricuspid stenosis are:
Congestion of the system, and dizziness during exertion, mainly occur due to reduced cardiac output. The decreased cardiac output shows symptoms like dyspnea, fatigue, exertional syncope, and stenosis of the mitral valve. The patient presents with swelling of the leg, inflammation, swelling of the stomach, anasarca, and hepatopathy due to congestion. The intensity of the murmur increases during strenuous work like squatting, leg raise, and exercises.
How Is Tricuspid Stenosis Evaluated?
The evaluation of tricuspid stenosis is done using the following steps, and they are:
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Laboratory Assessment: This is done by running blood and urine cultures to analyze the presence of elevated levels of serum markers which provide detection of the disease.
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Radiographs: These are two-dimensional imaging techniques where the radiograph of the chest helps diagnose expanded lungs or enlarged heart.
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Echocardiogram: Echocardiogram is a graphic representation of the heat beat, also called the waves. The study of echocardiogram in this condition shows elevated T and P waves (waves of the heartbeat).
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Cardiac Catheterization: This is the method of assessing the valve condition by injecting a dye through a catheter and allowing it to circulate throughout the system. This helps us to know the level of stenosis present.
How Is Tricuspid Stenosis Managed?
The management of tricuspid stenosis is mostly done by treating the underlying medical condition, as definitive management of tricuspid stenosis cannot be achieved due to a lack of clinical pieces of evidence. The following methods can manage tricuspid stenosis:
Medical Management: Patients are put on diuretics (drugs that increase the urinary output of the system). This helps the patient to get rid of the congestion of the system and liver. In syndrome-associated tricuspid stenosis, treating the diseases like SLE (systemic lupus erythematosus) and APLA (antiphospholipid antibody) prevents the thickening of the valves and bands of the tricuspids preventing obstruction. Also, discontinuing certain drugs like Fenfluramine and Methysergide has been effective.
Surgical management: Surgical management of tricuspid stenosis can be done in two ways:
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Valvotomy: This is a partial removal of the affected valve. This procedure is done by sending a balloon catheter through the vein and removing only the affected part. The removed area is then replaced with an artificial valve prosthesis.
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Valve Surgery: This surgery is done as a reparative surgery, which is used as a source for the repair and healing of the valve. When the choice of repair is not seen, it will proceed for an open valve replacement surgery.
What Are the Conditions that Resemble Tricuspid Stenosis?
There are a few other clinical conditions that resemble tricuspid stenosis, and they are;
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Regurgitation of the tricuspids occurring due to any cause.
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Dysfunctioning of the right ventricle due to any cause.
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Constrictive pericarditis.
How Is Tricuspid Stenosis Staged After Evaluation?
Staging the disease is the method of grouping the disease into multiple types based on clinical evaluation, scans, blood flow, and the structure of the valve vessels. Here in, tricuspid stenosis is staged into four types, namely stages A, B, C, and D.
Stage A - It categorized people as "At Risk" group.
Stage B - This stage defines a mild to moderately progressing disease where the patient is asymptomatic.
Stage C - Here, the disease progression is severe, but still, the patient is asymptomatic.
Stage D - This type defines severe and symptomatic disease.
What Are the Complications of Tricuspid Stenosis?
As tricuspid stenosis is a rare disease, its outcome is hardly studied, but the prognosis mostly depends on the associated underlying disease along with tricuspid stenosis. However, patients showing only symptoms of tricuspid stenosis have an excellent prognosis.
Although tricuspid stenosis is treatable, there are still a few complications that can be associated with it, and they are
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Atrial Fibrillation - It is a condition in which irregular heart rhythm is seen, which can cause blood clots in the heart.
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Heart Failure - It is a serious dysfunction of the heart to pump blood normally.
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Liver Failure - It is the loss of capacitance of the liver to function normally.
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Infective Endocarditis - It is a life-threatening infectious disease of the heart involving its chambers and valves.
Conclusion
It is important to educate people with risk factors about tricuspid stenosis and make them aware of the symptoms like swelling of the leg and abdomen, shortness of breath, unexplained dizziness, and blackouts. They should be asked to visit the doctor if the symptoms arise. Although the occurrence of tricuspid stenosis is rare, the symptoms are often associated with underlying features in conditions like rheumatic mitral stenosis, stroke, heart dysfunction, etc. But on early detection and management, the patient shows excellent outcomes with a successful treatment result. Hence tricuspid stenosis is preventable and manageable with patient education and early detection.
