Diagnosis and Treatment of Tricuspid Stenosis.

It has often been pointed out that tricuspid stenosis occurs much more frequently than it is diagnosed. This may be because it so rarely occurs as a single valvular defect (although such cases have been described), because there are no characteristic symptoms, and because clinical signs are often inconspicuous. In the past, it has not been considered of much practical importance to make the diagnosis but this is no longer the case owing to the availability of surgical treatment. Tricuspid stenosis is usually of rheumatic origin, but the condition may be congenital (Paul and Lev, 1960) and has been reported in carcinoid (Millman, 1943), fibro-elastosis (Dennis, Hansen, and Corpening, 1953), endomyocardial fibrosis (Davies and Ball, 1955), and lupus erythematosus (Gibson and Wood, 1955). The condition has been simulated by a right atrial myxoma (Lyons et al., 1958). This paper is concerned with the diagnosis, circulatory effects, and surgical treatment of rheumatic tricuspid stenosis associated with severe mitral stenosis, with particular reference to 17 patients who were studied in detail and then treated by combined valvotomy. It is noteworthy that we have not seen or at least not recognized severe tricuspid stenosis in association with isolated mitral incompetence or isolated aortic valvular disease.