Tricuspid Stenosis: Essential Diagnostic Tests You Should Know

Tricuspid stenosis is a rare heart valve disorder that restricts blood flow from the right atrium to the right ventricle. Early and accurate diagnosis is crucial for effective treatment planning. Several diagnostic tools are available to evaluate the severity and impact of tricuspid stenosis.

Chest X-Ray

In isolated tricuspid stenosis, a chest X-ray typically reveals significant enlargement of the right atrium along with dilation of the superior vena cava. However, the right ventricle remains normal in size, and there is no pulmonary artery dilation. Additionally, pulmonary vascularity appears reduced, which can be a key distinguishing feature from other heart conditions.

Electrocardiogram (ECG)

An ECG can provide important clues about the electrical activity of the heart. In patients with tricuspid stenosis, tall and peaked P waves in leads II, III, and aVF are commonly observed. These P waves often exceed 0.25 mV in amplitude, indicating right atrial enlargement. If the patient also has mitral stenosis, signs of right ventricular hypertrophy and right axis deviation may be present on the ECG tracing.

Echocardiography

M-Mode and Two-Dimensional Echocardiography

Echocardiography is one of the most valuable tools for diagnosing tricuspid stenosis. M-mode and 2D echocardiography often reveal thickened and highly reflective tricuspid valve leaflets with restricted mobility. The right atrium is typically enlarged, and dilation of the superior and inferior vena cava, as well as the hepatic veins, may be observed. The EF slope of the valve motion is reduced, and the leaflets may move in the same direction, indicating impaired opening.

Doppler Echocardiography

Doppler imaging allows for the assessment of blood flow across the tricuspid valve. By sampling the inflow tract in the right ventricle, a high-velocity jet during diastole can be detected. This provides a measurement of the pressure gradient across the valve. Color Doppler imaging further enhances diagnostic accuracy by visualizing a mosaic-colored jet in the two-dimensional plane, indicating turbulent flow due to stenosis.

Cardiac Catheterization

Before considering interventions like valvuloplasty or surgical commissurotomy, cardiac catheterization is often performed. This test measures the mean diastolic pressure gradient across the tricuspid valve. A gradient of 0.27 kPa (2 mmHg) or higher is indicative of significant tricuspid stenosis and helps confirm the diagnosis when other methods are inconclusive.

Jugular Venous Pulse Examination

Physical examination findings, particularly of the jugular venous pulse, can also aid in diagnosis. A prominent "a" wave is typically observed, reflecting increased right atrial pressure due to restricted valve opening. This finding, although not specific, supports the presence of tricuspid stenosis when combined with other clinical and diagnostic data.