Isolated tricuspid valvular stenosis

The seventh case of isolated tricuspid valvular stenosis is reported. Despite the rarity of this lesion, a number of distinguishing clinical features warrant emphasis. The patient is generally a woman who has had a known heart murmur since childhood and who complains of fatigue, dyspnea and edema. Helpful physical signs include a prominent jugular venous a wave, left parasternal presystolic rumble with little if any mid-diastolic component, and generally no opening snap. Both the a wave and the rumble are accentuated during inspiration. Signs of pulmonary vascular congestion are absent, and both the electrocardiogram and the chest roentgenogram reveal only right atrial enlargement. Cardiac catheterization demonstrates a tricuspid diastolic mean gradient of 4 to 8 mm Hg and a valve area ranging from 0.8 to 1.5 cm 2 . The clinical course is variable. In some cases tricuspid valvulotomy or valvuloplasty has resulted in considerable improvement.