Tricuspid stenosis

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 9 Mar 2025

Last updated: 02 Apr 2025

Tricuspid stenosis (TS) most commonly occurs as a late complication of acute rheumatic fever.

TS rarely occurs in the absence of associated rheumatic mitral and/or aortic disease.

Dyspnoea is a common finding and usually relates to concomitant mitral valve stenosis.

Prominent a-waves in the jugular venous wave form are a hallmark of tricuspid stenosis in patients who are in sinus rhythm.

Transthoracic echocardiogram with Doppler flow is accurate for diagnosis.

Most effective therapy is valve replacement.

Definition

TS is a rare condition defined by an abnormally elevated pressure gradient across the tricuspid valve during diastolic filling of the right ventricle.

History and exam

Key diagnostic factors

history of acute rheumatic fever (ARF) during childhood
dyspnoea
elevated jugular venous pressure with prominent a-wave
low-frequency pre-systolic (diastolic) murmur at lower left sternal border

Full details

Other diagnostic factors

age: 20-39 years
exercise intolerance
fatigue
jugular pulsations
abdominal swelling and discomfort
oedema
cyanosis or hypoxaemia
atrial fibrillation
hepatomegaly
ascites, oedema, anasarca
age: infancy or childhood
episodic facial flushing, watery diarrhoea, or bronchoconstriction
absent right ventricular lift or heave
opening snap
endocarditis stigmata (e.g., splinter haemorrhages, Osler nodes, Janeway lesions)

Full details

Risk factors

group A streptococcal (GAS) pharyngitis
metastatic carcinoid tumours
artificial tricuspid valve
intravenous drug use
pacemaker/defibrillator leads crossing tricuspid valve orifice
genetic predisposition and environmental factors

Full details

Diagnostic investigations

1st investigations to order

ECG
chest x-ray
2D transthoracic echocardiogram
Doppler transthoracic echocardiogram
liver function tests
blood biochemistry
FBC
blood cultures
24-hour urinary excretion of 5-hydroxy-indole acetic acid (5-HIAA)

Full details

Investigations to consider

cardiac catheterisation
cardiac MRI
3D transthoracic echocardiogram
cardiac CT angiography (CTA)
[18F] fluorodeoxyglucose (FDG)-PET/CT

Full details

Treatment algorithm

ACUTE

Contributors

Authors

John R. Charpie, MD, PhD

Professor

Pediatrics and Communicable Diseases

Division Director

Pediatric Cardiology

Medical Director

Pediatric Cardiothoracic ICU

University of Michigan Congenital Heart Center

Ann Arbor

Disclosures

JRC declares that he has no competing interests.

Jeffrey D. Zampi, MD

Associate Professor

Pediatrics and Communicable Diseases

Director, Interventional Pediatric Cardiology

University of Michigan Congenital Heart Center

Ann Arbor

Disclosures

JZ is a consultant for Medtronic Inc and Gore Medical. JZ serves on the data safety monitoring board for a clinical trial sponsored by Encore Medical. JZ has served as medical expert for several legal cases.

Amanda D. McCormick MD, null

Assistant Professor

Pediatrics and Communicable Diseases

University of Michigan Congenital Heart Center

Ann Arbor

Disclosures

ADM receives grant funding from the NIH.

Acknowledgements

Dr John R. Charpie, Dr Jeffrey D. Zampi, and Dr Amanda D. McCormick would like to gratefully acknowledge Dr Martin L. Bocks, a previous contributor to this topic.

Disclosures

MLB declares that he has no competing interests.

Peer reviewers

Lokesh Tejwani, MD, FACC

Assistant Professor of Clinical Medicine

University of Missouri Hospitals and Clinics

Harry S. Truman VA Hospital

Columbia

Disclosures

LT declares that he has no competing interests.

John Coltart, MD, FRCP, FACC, FESC, MRCS

Consultant Cardiologist

Cardio-thoracic Unit

Guy's and St Thomas' Hospital

London

Disclosures

JC declares that he has no competing interests.

Use of this content is subject to our disclaimer