About the disease
Tricuspid valve stenosis is the narrowing process of the tricuspid valve, when blood flows from the right atrium to the right ventricle is obstructed. During tricuspid valve stenosis right atrium becomes big in size and stretched and a patient may develop heart failure or atrial fibrillation.
Almost all cases of tricuspid valve stenosis are the result of rheumatic fever. It can also be caused by some congenital abnormalities or limited constrictive pericarditis. Patients who are diagnosed with carcinoid syndrome, which is a failure of various organs as a result of the presence in the body carcinoid, can develop tricuspid valve stenosis. Carcinoid is a small tumor, which is usually located in the small or large intestine. Tumor produces active substances, that damage endocardium. People are also in risk group if they have myocarditis, which is an inflammation of heart muscles. Such inflammation leads to the development of stenosis.
If not treated timely tricuspid valve stenosis can have such complications as pulmonary embolism, cardiac arrhythmias, atrial fibrillation. endocarditis and atrial fibrillation. The further prognosis mainly depends on the cause of tricuspid stenosis, presence of valvular lesions, success of the surgery and the severity of congestion in internal organs. The duration of life for patients who were diagnosed with tricuspid stenosis can range from a few days to a few decades. Nevertheless, if a patient had a successful operation he can live a long life. The biggest problem is that he can develop other heart defects in future if not observed regularly at the cardiologist`s. Usually people who had the operation of tricuspid valve stenosis are not advised to play sports and to do any physical work, which can intervene with the heart rhythm. There are, though, sports, that are allowed to be taken for patients who had tricuspid valve stenosis. Such sport include swimming and also physical exercises that relax a person. For instance, such exercises include yoga and pilates classes. A patient should also be aware of his heart rhythm and heart pressure. If he has a high blood pressure he may be prescribed with anti-arrhythmic drugs, but they should be taken very carefully, because there is always a chance of developing bradycardia, which is basically a low blood pressure. Dietary salt restrictions must be followed long after the operation, as salt does not agree with the work of arteries, which can narrow again and can cause the main lack of oxygen level in the patient's body.
Symptoms of severe tricuspid valve stenosis include pulsing neck discomfort, tiredness, always cold skin (it happens because of the low cardio output) and discomfort in the upper part of the abdomen (due to enlarged liver). Other symptoms are as follows:
- Irregular heartbeat
- Heaviness in the stomach
Almost all patients who have tricuspid valve stenosis have a blue coloration of the skin when the disease becomes severe. It is vital to visit the doctor when a person sees that his skin tone is changed, because there may be seizure and a person will not be able to breathe normally. In that case person will need an oxygen mask and some drugs that can widen the arteries and normalize the blood flow.
Diagnosis of any diseases begins with the analysis of medical history and patient`s complaints. Also a doctor asks if a patient had relatives with heart diseases or any infectious diseases. Genetic history may reveal rheumatoid process, which is the most common cause of tricuspid valve stenosis. During physical examination a doctor checks if the patient has either blue or yellow skin tone which can indicate that there is not enough oxygen in the lungs and body system of a person. Also patients with tricuspid valve stenosis can have swollen neck veins and abdominal enlargement. After physical examination a doctor is likely to listen to the detect if there is cardiac arrhythmias or any murmurs. Analysis of blood and urine can show if there is an inflammatory process. Also blood test determines level of cholesterol, blood sugar and creatinine.
- Electrocardiography (ECG) evaluates the rhythm of heartbeats. For tricuspid valve stenosis the ECG can identify narrowing in the right atrium.
- Phonocardiogram in tricuspid stenosis demonstrates the presence of noise in the valve. The noise is usually not overly audible and it is not always easy to detect.
- Echocardiography is the main method of determining the state of the valve, as it can show the size of the valve and its state. It is difficult to diagnose tricuspid valve stenosis, because it usually develops with other heart defects, such as tricuspid insufficiency.
If the case is not very severe, a patient usually needs to undergo conservative therapy and also follow dietary restrictions. For instance people with tricuspid valve stenosis need to eat no more than 3 gr of salt and drink 2 liters of water per day. Conservative therapy aims to reduce congestion in the organs and excrete excess fluid.
- Open heart surgery aims to repair leaflets of the tricuspid valve to normalize the blood flow.
- Percutaneous balloon valvuloplasty is a procedure during which the narrowed valve is widened with special baloon.
- Tricuspid valve replacement (artificial or biological) is implantation of the biological prosthesis or mechanical valve. It is performed if valve is unable to carry out its functions anymore. After implantation of mechanical prosthesis patient requires constant administration of drugs that reduce blood clotting by blocking the synthesis of liver substances. Biological prosthesis needs to be changed if it becomes not as effective as it used to be. Usually doctors use the natural prosthesis of such animals as bull, pig or cow. The human implant can also be used for this type of tricuspid valve stenosis surgery. Tricuspid valve stenosis treatment also includes drugs that can stop or prevent the process of narrowing of the arteries.
- Tricuspid commissurotomy aims to relieve the constriction between the valves, created by stenosis.