Predominant Rheumatic Tricuspid Stenosis

Diagnosis and management of multivalve disease could be challenging for clinicians. Rheumatic heart disease is a well-known etiology of multivalve disease.

A 51-year-old male with a history of rheumatic heart disease was referred to rule out infectious endocarditis. Three-dimensional (3D) transesophageal echocardiography (TEE) showed significant stenosis of the tricuspid valve, moderate tricuspid regurgitation, rheumatic mitral valve disease, and a bicuspid aortic valve.

Transthoracic echocardiography is the modality of choice for evaluation of cardiac valves and quantification of cardiac chambers. However, due to the complex nature of multivalve disease, using a complementary imaging technique such as 3D TEE becomes crucial in many patients. Tricuspid stenosis as the dominant valvular lesion in rheumatic heart disease is rare and almost always occurs in the presence of mitral valve disease. We present a unique case of rheumatic heart disease with the involvement of mitral and tricuspid valves in the presence of a bicuspid aortic valve, in which tricuspid stenosis is the predominant lesion. We also discuss the important role of cardiac imaging and 3D TEE in patient decision making.

Tricuspid stenosis as the dominant valvular lesion in rheumatic heart disease is rare and almost always occurs in the presence of mitral valve disease. Transthoracic echocardiography remains the modality of choice for evaluation of the tricuspid valve. 3D TEE can play an important role in reaching a final management decision.