Estenosis Tricuspídea Severa secundaria a enfermedad carcinoide cardiaca: presentación de caso clínico y revisión de la literatura / Severe Tricuspid Stenosis Secondary to Cardiac Carcinoid Disease: Case Report and Literature Review

RESUMEN: La estenosis tricuspídea (ET) es una valvulopatía infrecuente cuyas principales etiologías son la enfermedad reumática y la endocarditis infecciosa. En raras ocasiones puede deberse a un fenómeno carcinoide subyacente, en lo que se conoce como la enfermedad carcinoide cardiaca (ECC). Esta condición lleva a la fibrosis del endocardio del ventriculo derecho, principalmente de sus válvulas, lo cual puede provocar falla cardiaca derecha, complicando el pronóstico. En este artículo se presenta un caso de una ET severa por una posible ECC, en conjunto con las imagenes ecocardiográficas obtenidas durante el abordaje diagnóstico (imágenes bidimensionales, imagen multiplanar y ecocardiografía en 3D). Se discuten las implicaciones clínicas, los retos diagnósticos, las opciones terapeuticas y el pronóstico de esta rara entidad.

ABSTRACT Severe Tricuspid Stenosis Secondary to Cardiac Carcinoid Disease: Case Report and Literature Review Tricuspid stenosis is an unfrequent valvulopathy that can be caused by multiple etiologies, including rheumatic disease and infectious endocarditis. In rare occasions, it occurs in the context of a carcinoid syndrome, in what is known as carcinoid heart disease. This condition causes fibrosis of the valves and the endocardium of the right ventricule, which can progress into right ventricular failure, worsening the patient's prognosis. In this article, we present a case of a severe tricuspid stenosis in which this ethiology is suspected. We show the echocardiographic images obtained for the diagnosis (two-dimensional imaging, multimodal imaging and 3D echocardiography), and we discuss the clinical and diagnostic implications, therapeutic options and prognosis of this rare condition.

Tricuspid stenosis: A rare and potential complication of ventricular septal occluder device

Asymmetrical septal occluder device (ASOD) has made percutaneous closure of ventricular septal defect an easy and effective management option. Although there are reports of aortic and tricuspid valvular regurgitation after deployment of ASOD, only few cases of tricuspid stenosis (TS) has been reported so far in the literature. We report a case of malaligned ASOD that occurred after successful device closure resulting in TS along with mild tricuspid and aortic regurgitation requiring surgical retrieval. Transesophageal echocardiography played crucial role in detecting the cause of tricuspid valve dysfunction besides providing continuous monitoring during the procedure. We intend to emphasize the need of echocardiographic evaluation of the tricuspid valvular apparatus and aortic valve during and after the device deployment even after the successful device closure to prevent this rare complication.

A Case of Severe Tricuspid Stenosis of Rheumatic Origin.

Tricuspid valve stenosis is a valvular heart disease which results in the narrowing of the orifice of the tricuspid valve of the heart. It’s relatively a rare condition. It is almost always caused by rheumatic fever and is generally accompanied by mitral stenosis.Other rare causes include carcinoid syndrome, endocarditis, endomyocardial fibrosis, lupus erythematosus, right atrial myxoma and congenital tricuspid atresia. Here we describe a patient with history of prior CMC presented with severe Tricuspid Stenosis with Tricuspid Regurgitation (Grade-IV), Mitral Restenosis (Severe), Mitral Regurgitation (grade-1+), Aortic Stenosis (Mild) and Aortic Regurgitation (Grade-2).

A case of congenital tricuspid stenosis

Congenital tricuspid stenosis is an uncommon congenital heart anomaly. Tricuspid stenosis is usually associated with other anomalies, most commonly severe pulmonary stenosis or atresia with secondary hypoplasia of the right ventricle. Clinically it may be difficult to distinguish from tricuspid atresia. A case of congenital tricuspid stenosis in a 32 day-old-girl is presented. The patient had cyanosis and dyspnea. Echocardiographic study revealed tricuspid stenosis with right ventricular hypoplasia, atrial septal defect and pulmonary stenosis.

Noninvasive Evaluation of Rheumatic Tricuspid Stenosis with Doppler and 2 Dimensional Echocardiography

In order to determine the meaning of tricuspid stenosis(TS) in rhematic valvular heart disease(RVHD), 310 consecutive patients with RVHD were assessed by Doppler and 2-dimensional(2D) echocardiography. The frequency of 2D echocardiographic TS(diastolic doming of anterior tricuspid leaflet and thickened tricuspid leaflets) was 8.4%, and all patients with 2D echocardiographic TS had the mean tricuspid pressure gradient(MTPG) of 1mmHg or more compared to normal control of less than 1mmHg with Doppler echocardiography. The frequency of clinically significant hemodynamic TS(MTPG>2mmHg) and of servere hemodynamic TS(MTPG>5mmHg) in RVHD were 3.5% and 0.6% respectively. Rheumatic TS was accompanied by tricuspid regurgitation in the frequency of 92.3% and did not occurs in pure mitral regurgitation. Rhematic TS occurs with high frequency in advanced rheumatic valvular stenosis, and the frequency of rheumatic TS in severe rheumatic mitral stenosis and mitral stenosis coexing with aortic stenosis were 20.8% and 23.9% respectively. The results indicates that TS in RVHD is little practical meaning but is unable to disregard especially in the cases of advanced rhematic valvular stenosis, and there is need to recognize of TS in RVHD.