Juvenile tricuspid stenosis and rheumatic tricuspid valve disease: an echocardiographic study

Tricuspid valve involvement is not uncommon in patients with rheumatic hear t disease and is frequently missed on routine clinical examination. We pros pectively studied the echocardiographic profile of tricuspid valve disease in 788 consecutive patients with rheumatic heart disease. Out of these pati ents 9% (70) had tricuspid valve disease and 55.7% (39) of these were of le ss than or equal to 20 years of age. Of these 60% were females and 40% were males. Their ages ranged from 9 to 64 years (mean 24.2+/-13.6 years). Of t hese patients, 50% had tricuspid stenosis with or without tricuspid regurgi tation whereas 50% had isolated tricuspid regurgitation. Isolated tricuspid stenosis was present in 7.4% of these cases. All patients had associated m itral stenosis. Severe mitral stenosis was present more commonly in patient s with juvenile tricuspid stenosis compared to older patients (94.1% vs. 55 .6%, P<0.005). Mitral regurgitation was present more commonly in juvenile a ge group patients compared to older patients (53.8% vs. 25.8%, P<0.01). A c ombination of mitral, aortic and tricuspid stenosis was present in five cas es and four of these were in the juvenile age group. Left ventricular enlar gement and dysfunction were present in 28.6 and 14.3% patients, respectivel y, and the majority of these patients were in the juvenile age group (P<0.0 5). We conclude that rheumatic tricuspid valve disease occurs early in the course of the disease and progresses faster in India and is always associat ed with mitral stenosis. Juvenile tricuspid stenosis is more commonly assoc iated with severe mitral stenosis, mitral regurgitation, left ventricular e nlargement and dysfunction as compared with older patients. (C) 1999 Elsevi er Science Ireland Ltd. All rights reserved.