Surgical treatment of tricuspid stenosis.

In patients suffering with chronic valvular disease who are diagnosed as having mitral stenosis, there are found a few who have an associated tricuspid stenosis. The diagnosis of this combination of lesions is difficult. The unique opportunity to study the hemodynamics of "pure" tricuspid stenosis was presented when a patient, originally diagnosed as mitral stenosis, had in fact both lesions, and was treated by mitral commissurotomy. Subsequently tricuspid stenosis was suspected clinically and was demonstrated by serial catheterization studies. Tricuspid commissurotomy was performed four years after mitral commissurotomy. TFRICUSPID valvular disease in adults is usually rheumatic in origin. As seen in the mitral and aortic valves, severe anatomic distortion of the leaflets of the tri-cuspid valve produces insufficiency, stenosis, or an element of each. Such deformities, when slight, cause no physiologic derangements, but when marked interfere noticeably with cardio-vascular function. From a clinical standpoint, the terms adynamic and dynamic tricuspid disease seem applicable. Whereas insufficiency of the tricuspid valve may be primary when due to distorted valve leaflets, or secondary when due to changes incident to severe right heart failure, stenosis is always an organic involvement. The size of the orifice is of considerable importance in that there probably exists a critical area above which insufficiency predominates, and under which, stenosis predominates. This area has not as yet been closely defined and requires further observation. Rarely does this disease exist as a solitary valvular defect. Reports of autopsy studies' demonstrate that its highest incidence is in association with both aortic and mitral disease ; and its next highest incidence is in association with mitral valve involvement. A decisive clinical diagnosis usually can not be made because of the masking effects of the mitral valve lesion. Therefore, the successful surgical treatment for stenotic valvular diseases now imposes a greater demand for more accurate methods of diagnosis of stenosis of the tri-881 cuspid valve, since this lesion may no longer be regarded as having merely prognostic importance. Operative attempts have been made simultaneously on the combination of aortic and mitral stenosis with some success, but it is apparent that both of these valves, located as they are in the left heart, render operative appraisal less difficult and intervention more feasible. The tricuspid valve being on the side opposite requires a more formidable approach for simultaneous surgery, or else necessitates a two stage operation. The diagnosis of tricuspid stenosis is not easy to …