39
Tricuspid Stenosis
Table 22. Stages of Severe Tricuspid Stenosis (TS)
Stage Definition
Valve
Anatomy
Valve
Hemodynamics
Hemodynamic
Consequences Symptoms
C, D Severe TS Thickened,
distorted,
calcified
leaflets
• T½ ≥190 ms
• Valve area
≤1.0 cm
2
RA/IVC
enlargement
None or
variable and
dependent
on severity
of associated
valve disease
and degree of
obstruction
e transtricuspid diastolic gradient is highly variable and is affected by heart rate, forward flow,
and phases of the respiratory cycle. However, severe TS usually has ∆Pmeans >5–10 mm Hg at
heart rate 70.
Table 23. Diagnosis and Intervention in Patients With TS
Recommendations COR LOE
Diagnosis
TTE is indicated in patients with TS to assess the anatomy
of the valve complex, evaluate severity of stenosis, and
characterize any associated regurgitation and/or le-sided
valve disease.
I C
Invasive hemodynamic assessment of severity of TS may
be considered in symptomatic patients when clinical and
noninvasive data are discordant.
IIb C
Intervention
TV surgery is recommended for patients with severe TS at the
time of operation for le-sided valve disease.
I C
TV surgery is recommended for patients with isolated,
symptomatic severe TS.
I C
Percutaneous balloon tricuspid commissurotomy might be
considered in patients with isolated, symptomatic severe TS
without accompanying TR.
IIb C
