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Common Congenital Heart Lesions - page 25 / 126

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Stenotic Atrioventricular Valve Disease Tricuspid Stenosis (TS)

Clinical Presentation:

  • Can be similar to the symptoms of MS…please refer back to the clinical presentation for MS.

  • Note: TS and MS can be coexisting due to rheumatic heart disease.

Physical Exam:

  • Typical findings:

    • o

      auscultation: similar to MS…hear an “opening snap” (OS) after S2; OS followed by low-frequency decrescendo diastolic murmur – the murmur of TS is heard closer to the sternum and intensifies on inspiration due to increased right heart blood flow (more volume over stenosis = louder murmur)

      • o

        jugular venous pulse: neck waves are distended with a large “a” wave due to RA contraction against the stenotic tricuspid valve orifice

  • o

    patients may develop abdominal distention and hepatomegaly due to passive venous congestion

Pathology:

  • Typical path features of rheumatic TS come from acute and recurrent inflammation – like with MS, get fibrous thickening, calcification of valve leaflets, fusion of valve commissures, and thickening and shortening of the chordae tendineae.

Etiology:

  • TS is rare and usually a consequence of rheumatic heart disease.

Treatment:

  • Mechanical correction

oSurgical therapy usually required – either valvuloplasty or valve replacement.

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