Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Tricuspid stenosis

William H Gaasch, MD
Section Editor
Catherine M Otto, MD
Deputy Editor
Susan B Yeon, MD, JD, FACC


Tricuspid stenosis (TS) is an uncommon valvular abnormality that most commonly occurs in association with other valvular lesions, particularly in patients with rheumatic heart disease. For many years, surgical commissurotomy and valvuloplasty were the only available methods to correct TS. The development of balloon valvotomy techniques has revolutionized the management of mitral stenosis. Similar techniques can be used to treat TS, although data on treatment of TS are limited. (See "Percutaneous mitral balloon valvotomy for mitral stenosis".)

The clinical features of TS and the management of patients with this lesion will be reviewed here.


Tricuspid stenosis (TS) is most commonly of rheumatic etiology. The majority of cases of tricuspid rheumatic disease present with tricuspid regurgitation or a combination of regurgitation and stenosis; pure TS is very uncommon [1,2]. Rheumatic tricuspid disease almost never occurs as an isolated lesion, but is generally associated with mitral valve disease and, in some cases, aortic valve disease [3,4]. In an angiographic study of 525 patients with rheumatic heart disease, 9 percent had TS and all patients with TS also had significant tricuspid regurgitation [5].

Other causes of flow obstruction at the level of the tricuspid valve include:

Congenital atresia or stenosis of the valve [6,7]. (See "Tricuspid valve (TV) atresia".)

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: May 22, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Hauck AJ, Freeman DP, Ackermann DM, et al. Surgical pathology of the tricuspid valve: a study of 363 cases spanning 25 years. Mayo Clin Proc 1988; 63:851.
  2. Daniels SJ, Mintz GS, Kotler MN. Rheumatic tricuspid valve disease: two-dimensional echocardiographic, hemodynamic, and angiographic correlations. Am J Cardiol 1983; 51:492.
  3. Roguin A, Rinkevich D, Milo S, et al. Long-term follow-up of patients with severe rheumatic tricuspid stenosis. Am Heart J 1998; 136:103.
  4. Sharma S, Loya YS, Desai DM, Pinto RJ. Percutaneous double-valve balloon valvotomy for multivalve stenosis: immediate results and intermediate-term follow-up. Am Heart J 1997; 133:64.
  5. Yousof AM, Shafei MZ, Endrys G, et al. Tricuspid stenosis and regurgitation in rheumatic heart disease: a prospective cardiac catheterization study in 525 patients. Am Heart J 1985; 110:60.
  6. Cohen ML, Spray T, Gutierrez F, et al. Congenital tricuspid valve stenosis with atrial septal defect and left anterior fascicular block. Clin Cardiol 1990; 13:497.
  7. Tennstedt C, Chaoui R, Körner H, Dietel M. Spectrum of congenital heart defects and extracardiac malformations associated with chromosomal abnormalities: results of a seven year necropsy study. Heart 1999; 82:34.
  8. Nisanci Y, Yilmaz E, Oncul A, Ozsaruhan O. Predominant tricuspid stenosis secondary to bacterial endocarditis in a patient with permanent pacemaker and balloon dilatation of the stenosis. Pacing Clin Electrophysiol 1999; 22:393.
  9. Unger P, Clevenbergh P, Crasset V, et al. Pacemaker-related endocarditis inducing tricuspid stenosis. Am Heart J 1997; 133:605.
  10. Hagers Y, Koole M, Schoors D, Van Camp G. Tricuspid stenosis: a rare complication of pacemaker-related endocarditis. J Am Soc Echocardiogr 2000; 13:66.
  11. Essandoh M, Zuleta-Alarcon A, Weiss R, et al. Transesophageal echocardiographic diagnosis of severe functional tricuspid stenosis during infected implantable cardioverter-defibrillator lead extraction. J Cardiothorac Vasc Anesth 2015; 29:412.
  12. Rosenberg Y, Myatt JP, Feldman M, et al. Down to the wire: tricuspid stenosis in the setting of multiple pacing leads. Pacing Clin Electrophysiol 2010; 33:e49.
  13. Heaven DJ, Henein MY, Sutton R. Pacemaker lead related tricuspid stenosis: a report of two cases. Heart 2000; 83:351.
  14. Saito T, Horimi H, Hasegawa T, Kamoshida T. Isolated tricuspid valve stenosis caused by infective endocarditis in an adult: report of a case. Surg Today 1993; 23:1081.
  15. Gur AK, Odabasi D, Kunt AG, Kunt AS. Isolated tricuspid valve repair for Libman-Sacks endocarditis. Echocardiography 2014; 31:E166.
  16. Reddy G, Ahmed M, Alli O. Percutaneous valvuloplasty for severe bioprosthetic tricuspid valve stenosis in the setting of infective endocarditis. Catheter Cardiovasc Interv 2015; 85:925.
  17. Lilly SM, Rome J, Anwaruddin S, et al. How should I treat prosthetic tricuspid stenosis in an extreme surgical risk patient? EuroIntervention 2013; 9:407.
  18. Mao M, Madhavan M, Blauwet L, et al. Bioprosthetic tricuspid valve stenosis in end-stage renal failure. Am J Med Sci 2012; 343:252.
  19. Fisher J. Jugular venous valves and physical signs. Chest 1984; 85:685.
  20. Morgan JR, Forker AD, Coates JR, Myers WS. Isolated tricuspid stenosis. Circulation 1971; 44:729.
  21. Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 63:e57.
  22. Pérez JE, Ludbrook PA, Ahumada GG. Usefulness of Doppler echocardiography in detecting tricuspid valve stenosis. Am J Cardiol 1985; 55:601.
  23. Baumgartner H, Hung J, Bermejo J, et al. Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. J Am Soc Echocardiogr 2009; 22:1.
  24. Bonow RO, Carabello BA, Chatterjee K, et al. 2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation 2008; 118:e523.
  25. Paulus BM, Ali S, Zia AA, et al. Causes and consequences of systemic venous hypertension. Am J Med Sci 2008; 336:489.
  26. Rama-Merchan JC, Arribas-Jimenez A, Martin-Moreiras J, et al. Pacemaker lead-related tricuspid stenosis successfully treated with percutaneous balloon valvuloplasty guided by 3D echocardiography. Rev Port Cardiol 2014; 33:739.e1.
  27. Michiels V, Delabays A, Eeckhout E. Percutaneous balloon valvotomy for the treatment of pacemaker lead-induced tricuspid stenosis. Heart 2014; 100:352.
  28. Hussain T, Knight WB, McLeod KA. Lead-induced tricuspid stenosis--successful management by balloon angioplasty. Pacing Clin Electrophysiol 2009; 32:140.
  29. Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC), European Association for Cardio-Thoracic Surgery (EACTS), Vahanian A, et al. Guidelines on the management of valvular heart disease (version 2012). Eur Heart J 2012; 33:2451.
  30. Lee R, Li S, Rankin JS, et al. Fifteen-year outcome trends for valve surgery in North America. Ann Thorac Surg 2011; 91:677.
  31. Vassileva CM, Shabosky J, Boley T, et al. Tricuspid valve surgery: the past 10 years from the Nationwide Inpatient Sample (NIS) database. J Thorac Cardiovasc Surg 2012; 143:1043.
  32. Sancaktar O, Kumbasar SD, Semiz E, Yalçinkaya S. Late results of combined percutaneous balloon valvuloplasty of mitral and tricuspid valves. Cathet Cardiovasc Diagn 1998; 45:246.
  33. Yeter E, Ozlem K, Kiliç H, et al. Tricuspid balloon valvuloplasty to treat tricuspid stenosis. J Heart Valve Dis 2010; 19:159.
  34. Hoendermis ES, Douglas YL, van den Heuvel AF. Percutaneous Edwards SAPIEN valve implantation in the tricuspid position: case report and review of literature. EuroIntervention 2012; 8:628.
  35. Calvert PA, Himbert D, Brochet E, et al. Transfemoral implantation of an Edwards SAPIEN valve in a tricuspid bioprosthesis without fluoroscopic landmarks. EuroIntervention 2012; 7:1336.
  36. Roberts PA, Boudjemline Y, Cheatham JP, et al. Percutaneous tricuspid valve replacement in congenital and acquired heart disease. J Am Coll Cardiol 2011; 58:117.
  37. McGrath LB, Gonzalez-Lavin L, Bailey BM, et al. Tricuspid valve operations in 530 patients. Twenty-five-year assessment of early and late phase events. J Thorac Cardiovasc Surg 1990; 99:124.
  38. Kunadian B, Vijayalakshmi K, Balasubramanian S, Dunning J. Should the tricuspid valve be replaced with a mechanical or biological valve? Interact Cardiovasc Thorac Surg 2007; 6:551.
  39. Rizzoli G, Vendramin I, Nesseris G, et al. Biological or mechanical prostheses in tricuspid position? A meta-analysis of intra-institutional results. Ann Thorac Surg 2004; 77:1607.
  40. Ribeiro PA, Al Zaibag M, Al Kasab S, et al. Percutaneous double balloon valvotomy for rheumatic tricuspid stenosis. Am J Cardiol 1988; 61:660.
  41. Orbe LC, Sobrino N, Arcas R, et al. Initial outcome of percutaneous balloon valvuloplasty in rheumatic tricuspid valve stenosis. Am J Cardiol 1993; 71:353.
  42. Patel TM, Dani SI, Shah SC, Patel TK. Tricuspid balloon valvuloplasty: a more simplified approach using inoue balloon. Cathet Cardiovasc Diagn 1996; 37:86.
  43. Ashraf T, Pathan A, Kundi A. Percutaneous balloon valvuloplasty of coexisting mitral and tricuspid stenosis: single-wire, double-balloon technique. J Invasive Cardiol 2008; 20:E126.
  44. Sobrino N, Calvo Orbe L, Merino JL, et al. Percutaneous balloon valvuloplasty for concurrent mitral, aortic and tricuspid rheumatic stenosis. Eur Heart J 1995; 16:711.
  45. Ribeiro PA, al Zaibag M, Idris MT. Percutaneous double balloon tricuspid valvotomy for severe tricuspid stenosis: 3-year follow-up study. Eur Heart J 1990; 11:1109.