[Clinical conference. Evaluation of tricuspid valve stenosis].
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Tricuspid stenosis was treated in four patients by percutaneous balloon valvotomy. A mean pressure gradient equal or higher than 3 mmHg across the tricuspid valve using Doppler echocardiography and the increase of this pressure gradient during inspiration were the most significant criteria for diagnosis and quantification of tricuspid stenosis. There was a considerable hemodynamic improvement with reduction of the tricuspid valve gradient and relief of symptoms after balloon tricuspid valvotomy.
A patient developed acute, severe hemodynamic deterioration five days after an aortic valve replacement. Cardiac catheterization revealed a markedly elevated right atrial pressure but a normal right ventricular end-diastolic pressure. Angiography revealed an extrinsic mass causing compression of the right atrium and the tricuspid anulus. A large clot overlying the right atrium and ventricle was found at emergency surgery. Postoperative cardiac tamponade may result in an atypical hemodynamic presentation when there is selective compression of one chamber or of a valve anulus.
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