6th May 2025

Other valvular disease

Tricuspid stenosis

Stenosis of the tricuspid valve is uncommon. Where it occurs, it is frequently rheumatic in origin and thus associated with other valve disease. Other causes include carcinoid and drug-induced valve disease. Echocardiography is the primary form of assessment, and while there are no standard criteria for stenosis, 2d assessment of morphology and transtricuspid gradient of >5mmHg is suggestive of tricuspid stenosis. Interventional treatment, where required, is typically performed with bioprosthetic valves due to high rates of mechanical valve thrombosis.

Symptoms and will typically be those of right heart failure and venous congestion, while signs will include a raised JVP, peripheral oedema and a systolic murmur heard loudest at the left upper sternal edge on inspiration.

Pulmonary regurgitation

Pulmonary regurgitation of any degree is frequently noted on echocardiography. Isolated pulmonary regurgitation is rarely symptomatic but for those patients with severe valve disease, replacement can be considered but it is not a common procedure. 

Where present it is often congenital, or can be acquired after surgical repair of the pulmonary stenosis seen in tetralogy of Fallot. 

Echo criteria for severe pulmonary regurgitation are less well validated, though colour flow reversal of pulmonary flow seen in a branch pulmonary artery is suggestive of severe disease.

Symptoms and signs of severe disease will include those of right heart volume overloading – raised JVP, peripheral oedema and ascites.

Pulmonary stenosis

Stenosis of the pulmonary valve is another uncommon disease and, where seen, is mostly congenital in nature. Significant stenosis can be seen as part of the tetralogy of Fallot, but mid stenosis is typically asymptomatic and has a long-term benign prognosis. Where needed, interventional treatment is typically with percutaneous balloon valvuloplasty and surgical intervention and valve replacement is reserved only for those cases that have failed percutaneous treatment or otherwise have a contraindication.