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Tricuspid Stenosis.

Definition.—Tricuspid stenosis is an obstruction of the tricuspid opening, usually congenital, though it may be acquired.

Etiology.—This is the rarest of all heart-lesions, and one that is generally congenital. It is also rarely, if ever, found as an independent disease, being usually associated with disease of the left heart. In these combined forms, rheumatism has been found to be a causal factor. It is very much more frequent in females than in males; thus of 114 cases recorded by Leudet, 80 per cent were found in females, while of 46 cases reported by Fenwick, 38 were in women.

The frequency with which the disease is found with other valve lesions may be seen by referring to Leudet's classification of 114 cases. Thus in 11 cases, the tricuspid valve was alone involved, the tricuspid, mitral, and aortic valves in 21 cases; while the tricuspid and mitral valves were found involved in 78 cases.

Pathology.—The valves may be thickened with a partial fusion of the segments. The other morbid changes are necessarily about the same as are found in mitral stenosis and tricuspid insufficiency. There can be only one result from such obstruction; namely, dilatation of the right auricle, with engorgement of the venous system, disturbing the various viscera. The right ventricle hypertrophies, owing to increased tension in the pulmonary circulation, through mitral stenosis.

Symptoms.—The general symptoms are those of venous engorgement, and are similar to those of tricuspid insufficiency. Hemorrhoids, enlargement of the liver, and cerebral congestion follow of necessity, with dropsy following as the engorgement increases.

Physical Signs.—Inspection.—Slight presystolic pulsation is seen in the jugulars and general cyanosis is pronounced.

Palpation.—Over the right ventricle may be noticed a presystolic thrill.

Percussion.—Dullness extending to the right of the sternum, due to the enlarged auricle, will be found to be characteristic.

Auscultation.—A presystolic murmur may be heard over the lower part of the sternum, terminating in a sharp first sound, if the case be uncomplicated; but in the very great number of cases there is such a confusion and combination of murmurs owing to the various complications, that there can not be said to be any characteristic murmurs.

Diagnosis.—Owing to the complications or associated valvular lesions, the differential diagnosis between stenosis and insufficiency is almost impossible.

The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.

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