Severe tricuspid stenosis revealed after aortic valvotomy.

Surgical treatment of a rheumatic valvular lesion may exaggerate the physical signs or lead to the recognition for the first time of another valvular lesion. This is seen in combined lesions of the aortic and mitral valves and less frequently of the mitral and tricuspid valve. Tricuspid stenosis (Pantridge and Marshall, 1957) and tricuspid incompetence (Mounsey, 1959) have been revealed after mitral valvotomy but not after aortic valvotomy. This is probably due to the fact that rheumatic tricuspid disease is nearly always associated with mitral disease, less commonly with mitral and aortic valve disease and rarely with aortic disease alone (Gibson and Wood, 1955; Goodwin et al., 1957; Killip and Lukas, 1958; Perloff and Harvey, 1960). The following case report is of a young patient in whom tricuspid stenosis was revealed after aortic valvotomy. The tricuspid lesion accounted for unexpected failure to improve after a technically successful aortic valvotomy but its surgical correction at a second operation led to marked clinical improvement.