Some Auscultatory and Phonocardiographic Features of Tricuspid Stenosis

DESPITE considerable progress in the clinical diagnosis of rheumatic tricuspid stenosis, the lesion remains infrequently recognized. Its reported incidence among cases of multivalvular heart disease diagnosed during life is in the region of 2 to 3 per cent," 2 whereas it is more frequently (10 to 23 per cent) detected at autopsy3-6 or surgical exploration.7 Clinical recognition of tricuspid stenosis, even in mild form, is important for several reasons: its features may mimic right heart failure and may mislead the clinician in the assessment of the severity of coexisting valvular disease; 1 as a result of its presence, patients may fail to improve after successful mitral or aortic9 valvotomy; aortic or pulmonary insufficiency may be diagnosed incorrectly because of the diastolic murmur of tricuspid stenosis; a strong clinical suspicion of the diagnosis will prompt the use of a double-lumen cardiac catheter to record simultaneous right atrial and ventricular pressures, since a significant diastolic pressure gradient may be missed on simple withdrawal of an ordinary catheter across the tricuspid valve.'0 The purpose of this report is to present the auscultatory and phonocardiographic features in nine cases of tricuspid stenosis with special reference to some features inadequately emphasized in the literatulre. Appreciation of these features resulted in an increased awareness of the condition, six of the cases being thereby correctly diagnosed within the past year.