Tricuspid valve stenosis

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Classification according to ICD-10
I07.0 Tricuspid valve stenosis
ICD-10 online (WHO version 2019)

The Trikuspidalklappenstenose shortly also tricuspid stenosis (TS), belongs to the class of heart failure , and here to the heart valve defects . Due to a stenosis (constriction), the opening (the ostium ) of the tricuspid valve (heart valve between the right atrium and the right ventricle ) is narrowed, which disrupts the filling of the right ventricle during diastole (relaxation and filling phase of the heart).

causes

The rare tricuspid valve stenosis is usually caused by rheumatic fever , tumors and thrombi can also be the cause. Systemic lupus erythematosus , carcinoid syndrome , right atrial myxoma and localized constrictive pericarditis are less common . Etiologically , external pressure on the tricuspid ring from a tumor, from an infiltrating primary sarcoma or from metastases is even less likely . TS also occurs together with Libman-Sacks endocarditis . Congenital tricuspid valve stenosis results from adhesion of the closure margins; it is mostly combined with pulmonary valve atresia and with consecutive hypoplasia of the right ventricle. Isolated tricuspid valve stenosis is extremely rare.

Symptoms

Tricuspid valve stenosis often causes loss of appetite , vomiting , fatigue, tiredness , cold skin, and abdominal pain in the right upper quadrant and belching of air in a patient . In severe cases, edema , ascites , hepatomegaly (congested liver, liver congestion with pulsations ), cyanosis , dyspnoea and other symptoms of right heart failure can occur. As a result of the reduced cardiac output , physical performance is reduced . The formation of thrombi and the development of atrial fibrillation are described as complications . Tricuspid stenosis occurs together with mitral valve and often aortic valve defects.

diagnosis

With tricuspid valve stenosis, the valve opening area (SCF) is reduced. There is a venous congestion with congested neck veins. During auscultation , typical diastolic noises and the first loud heart sound (tricuspid opening sound) can be heard with the stethoscope . With echocardiography , the end-diastolic filling volume and may ejection fraction of the right atrium and other parameters are quantified. The cardiac output decreases. The diastolic atrioventricular (transtricuspid) pressure gradient in the right half of the heart is enlarged in the right heart catheter examination . On the ECG , the stenosis is characterized by high and pointed P waves ( P-pulmonary, P-dextroatriale, P-dextrocardiale ), by a PQ segment lengthening and by right atrial hypertrophy . The chest x-ray shows an enlargement of the right atrium. There is neither right ventricular hypertrophy nor right heart overload, nor does pulmonary congestion .

therapy

Surgical or interventional treatment options for defective tricuspid valves are valvuloplasty , valvulotomy , heart valve reconstruction and heart valve replacement surgery . Patients with the above symptoms should follow a low-salt diet and take diuretics and ACE inhibitors if necessary . Because of their volume-reducing effect, however, the diuretics and the salt restriction reduce the cardiac output and thus aggravate the heart failure . Endocarditis prophylaxis is recommended .

literature

  • Klaus Holldack, Klaus Gahl: Auscultation and percussion. Inspection and palpation. Thieme, Stuttgart 1955; 10th, revised edition ibid 1986, ISBN 3-13-352410-0 , p. 175 f.

Web links

Individual evidence

  1. ↑ Willibald Pschyrembel: Clinical Dictionary. 266th edition. De Gruyter, Berlin / Boston 2014, ISBN 978-3-11-033997-0 , pp. 2159 and 2160.
  2. ↑ The MSD Manual. 6th, German-language edition. Urban & Fischer , Munich / Jena 2000, ISBN 3-437-21750-X , p. 2138.
  3. ↑ Maxim Zetkin and Herbert Schaldach: Dictionary of Medicine. 15th edition. Ullstein Mosby publishing house, Berlin 1992, ISBN 3-86126-018-2 , p. 2151.
  4. ^ Günter Thiele: Handlexikon der Medizin. Volume 4, Urban & Schwarzenberg , Munich / Vienna / Baltimore 1980, p. 2490. - Almost literally also in: Roche Lexicon Medicine. 3. Edition. Urban & Schwarzenberg, 1993, ISBN 3-541-11213-1 , p. 1667.
  5. ↑ a b Klaus D. Scheppokat: Heart valve diseases . In: Walter Siegenthaler and others (ed.): Textbook of internal medicine. 3. Edition. Thieme-Verlag , Stuttgart / New York 1992, ISBN 3-13-624303-X , p. 96.
  6. ^ Cook-Sup So: Practical Electrocardiography. Selecta-Verlag, Planegg before Munich 1974, p. 44.
  7. ↑ Otto M. Hess, Rüdiger WR Simon (Ed.): Herzkatheter. Springer-Verlag, Berlin / Heidelberg 2000, ISBN 3-642-62957-1 , p. 488.
  8. ^ RA Hope et al: Oxford Handbook of Clinical Medicine. 4th edition. Oxford University Press , Oxford / New York / Tokyo 1998, ISBN 0-19-262783-X , p. 310.