Clinical and hemodynamic studies of tricuspid stenosis.

Five patients with tricuspid stenosis accompanying mitral stenosis were studied. The characteristic features include a diastolic rumbling murmur in the tricuspid area, accentuated by inspiration, prominent "a" wave in the jugular pulse, prominent P wave in the electrocardiogram, absence of physical or electrocardiographic signs of right ventricular hypertrophy, and disproportionate right atrial enlargement by fluoroscopy. The diagnosis may be confirmed by the presence of a significant diastolic pressure gradient across the tricuspid valve. Mitral valvuloplasty alone produces no improvement. The concept of "functional tricuspid stenosis" is introduced and a one-stage operative technic for both mitral and triscuspid valvuloplasty described.