The narrowing of the right atrioventricular holes (tricuspid stenosis)

  • Electrocardiographic study
  • Phonocardiographic study
  • X-ray data
  • Diagnosis and differential diagnosis
  • The narrowing of the right atrioventricular hole - tricuspid stenosis - stenosis ostii atrioventricular dextra. Acquired stenosis of the right venous mouth as children are very rare (A. N. Volovik, 1955; Was kiss, D. Strelli, 1962).
    According to Y. S. Petrosyan (1965), on the basis described in the literature sectional materials "clean" tricuspid stenosis was found in 18 of 3641 patient rheumatic heart disease etiology. Therefore, this defect is extremely rarely isolated, often combined with mitral vices, which is also confirmed by data Yu. S. Petrosyan: from 136 patients with tricuspid stenosis last 135 patients were combined with mitral fault, and only in one case - with aortic stenosis. The area of the right atrioventricular holes more space left, so hemodynamically significant tricuspid stenosis is the narrowing of the area of the right venous holes up to 3.0 cm2 and less.
    The pathogenesis of disorders of blood circulation. When narrowing of the right atrioventricular hole is difficult for the promotion of blood from the right atrium into the right ventricle. This leads to hyperthyroidism and hypertrophy of the right ventricle. Relatively weak right atrium can not long to ensure normal hemodynamics, resulting develop its dilation and stagnation of blood in the pulmonary circulation. When tricuspid stenosis falls sharply diastolic filling of the right ventricle. The pressure in a small range even when combined tricuspid stenosis with mitral disease is reduced. In connection with reduction of blood flowing in the pulmonary vessels, reduces the amount of blood in the left ventricle, reduced cardiac output. The increase of pressure in the right atrium leads to an increase of venous pressure of the great circle, and therefore develop congestion in the liver, cirrhotic changes in it and you receive ascites.
    The clinical picture. Clinical diagnosis of disease is very difficult because of the narrowing of the right atrioventricular hole almost never occurs in isolation but, as a rule, in combination with mitral, rarely with aortic valve diseases. Therefore, the symptoms of disease how would overlap with the symptoms of other valves. In addition, according to therapists (C. E. Nezlin, 1968; I. A. Cashiers, 1972), auscultatory signs of this Vice is less pronounced than with mitral stenosis. In these patients, there are significant fatigue, shortness of breath on exertion, heaviness and pain in the right hypochondrium, the increase in the abdomen.
    At survey found zianoz lips and nose, fingers and toes. This is due to a reduction in minute volume of circulatory and venous stasis.
    The tricuspid valve stenosis is inherent presistolic ripple neck veins and liver and high Central venous pressure is 200-400 mm waters. Art. (E. A. Damir, 1962; B. C. Soloviev, 1962; C. E. Nezlin, 1968, and others). Along with this, there was a slight pressure in the pulmonary circulation.
    When tricuspid stenosis allocate phase compensation, which is characterized by the absence of stagnation in the pulmonary circulation, and the phase of decompensation.
    The relative state compensation when narrowing of the right atrioventricular holes supported the expansion cavity and muscle hypertrophy of the right ventricle. During examination of the heart oblast showed no signs of increase and the pulsations of the right ventricle, accent of II tone of the pulmonary artery. Auscultation of the lower part of the sternum, sometimes over xiphoid process, is determined by clapping I tone and diastolic murmur nature presistolic. This noise is amplified in the patient on the right side. Strengthening tone I on the inhale and noise in the patient on the right side confirms the diagnosis narrowing of the right atrioventricular holes. The combination of this blemish with mitral stenosis and obstruction evaluation of diastolic noise, it is recommended to move the stethoscope over the region of the heart. You can hear two maximum sound diastolic noise is one maximum noise at the apex of the heart, the other - in the sternum. In patients with tricuspid stenosis in the sternum are heard and systolic murmur, due to co tricuspid insufficiency.