The Forgotten Valve: Isolated Severe Tricuspid Valve Stenosis.

Abstract

A 67-year-old white man with a history of coronary artery disease status, post–3-vessel coronary artery bypass grafting (13 years earlier) and ischemic heart disease, presented with fatigue and dyspnea on exertion for 6 months. He had undergone chronic resynchronization therapy defibrillator placement 9 months before. He denied any weight gain, paroxysmal nocturnal dyspnea, orthopnea, or lower extremity edema. On physical examination, jugular venous pressure was elevated at 12 cm H2O with prominent a and v waves and positive hepatojugular reflux. He had a grade II/VI systolic ejection murmur at the right upper sternal border and a I/IV holosystolic murmur at the right lower sternal border. His lungs were clear to auscultation, and he had no lower extremity edema. ECG demonstrated sinus rhythm at a ventricular rate of 90 beats/min. The pulmonary function test and overnight oximetry were within normal limits. The treadmill exercise test was notable for cardiac limitation with peak Vo2 of 14.5 mL·kg–1·min–1 (56% predicted) and abnormal pulmonary response with high Ve/Vco2 and decrease in oxygen saturation to 85% with exercise from 94% at rest. Transthoracic echocardiogram was notable for severe …