---
title: Tricuspid stenosis
description: What tricuspid stenosis (narrowing of the tricuspid valve) is, why it develops, how it shows itself and how it is found, which treatment approaches clinical guidelines describe, and when urgent help is needed.
type: disease
aliases:
  - TS
  - tricuspid valve stenosis
  - narrowing of the tricuspid valve
  - rheumatic tricuspid stenosis
sources:
  - tier: guideline
    org: esc
    title: 2025 ESC/EACTS Guidelines for the management of valvular heart disease
    year: 2025
    doi: 10.1093/eurheartj/ehaf194
    url: https://doi.org/10.1093/eurheartj/ehaf194
  - tier: guideline
    org: minzdrav-rf
    title: Митральный стеноз
    year: 2025
    url: https://cr.minzdrav.gov.ru/view-cr/945_1
  - tier: reference
    org: msd-manuals
    title: Tricuspid Stenosis (MSD Manual Professional Version)
    year: 2025
    url: https://www.msdmanuals.com/professional/cardiovascular-disorders/valvular-disorders/tricuspid-stenosis
  - tier: reference
    org: msd-manuals
    title: Tricuspid Stenosis (MSD Manual Consumer Version)
    year: 2025
    url: https://www.msdmanuals.com/home/heart-and-blood-vessel-disorders/heart-valve-disorders/tricuspid-stenosis
sources_checked: 2026-10-14
review: null
---

Tricuspid stenosis is a narrowing of the opening of the <Structure id="tricuspid-valve">tricuspid valve</Structure>, which lies between the <Structure id="right-atrium">right atrium</Structure> and the <Structure id="right-ventricle">right ventricle</Structure>. Because of the narrowing, blood passes less easily from the atrium into the ventricle.<Cite n={[3, 4]} /> Among acquired valve diseases in high-income countries, it is very rare.<Cite n={1} />

The cause is almost always past rheumatic fever, and the mitral valve is almost always affected along with the tricuspid valve.<Cite n={3} /> The condition is usually benign.<Cite n={3} />

<Diagram name="tricuspid-stenosis">
  <p slot="normal">
    The diagram shows diastole, when the right ventricle fills with blood. Blood from the body
    returns through the veins to the right atrium. Normally the tricuspid valve is open at this
    time, and blood passes freely from the right atrium into the right ventricle; when the ventricle
    contracts, the valve closes and stops blood from flowing back.<Cite n={4} />
  </p>
  <p slot="disease">
    In tricuspid stenosis the valve leaflets are thickened and move little, and the opening is
    narrowed.<Cite n={[3, 4]} /> Blood is held back in the right atrium: over the years it enlarges,
    and pressure rises in the veins that bring blood back to the heart from the body.<Cite n={4} />
    The right ventricle receives less blood and stays small.<Cite n={[3, 4]} /> A chest X-ray may
    show a widened superior vena cava.<Cite n={3} />
  </p>
</Diagram>

## Why it happens

<Patient>

In almost all cases the cause is rheumatic fever. It is a childhood illness that follows some cases of untreated strep throat or scarlet fever.<Cite n={[3, 4]} /> Where these infections are widely treated with antibiotics, for example in North America and Western Europe, rheumatic fever is rare.<Cite n={4} /> More in the articles on [acute rheumatic fever](../acute-rheumatic-fever/) and [rheumatic heart disease](../rheumatic-heart-disease/).

The valve leaflets become thick and stiff, and the opening narrows. Often the stiff valve also does not close completely, so [tricuspid regurgitation](../tricuspid-regurgitation/) is added to the stenosis.<Cite n={4} /> Rheumatic disease of the mitral valve, usually [mitral stenosis](../mitral-stenosis/), is almost always present as well.<Cite n={3} />

Rare causes, according to MSD, are a tumour in the right atrium, connective tissue diseases (for example, systemic lupus erythematosus), tumour metastases and, even more rarely, a birth defect of the tricuspid valve.<Cite n={[3, 4]} /> The European guidelines also name carcinoid syndrome and rare diseases such as [Fabry disease](../fabry-disease/) and Whipple's disease.<Cite n={1} />

</Patient>

<Student>

Almost all cases result from rheumatic fever; TR and rheumatic mitral valve disease (usually MS) are almost always present too.<Cite n={3} /> MSD lists SLE, RA myxoma, congenital malformations and metastatic tumours as rare causes.<Cite n={3} /> ESC 2025 associates TS mainly with rheumatic valve disease, carcinoid syndrome and certain rare diseases such as Fabry disease and Whipple's disease.<Cite n={1} /> The sources list causes differently, so the lists are not merged here.

The RA becomes hypertrophied and distended; sequelae of heart failure caused by right heart disease develop, but without RV dysfunction: the RV remains underfilled and small.<Cite n={3} /> Atrial fibrillation is uncommon.<Cite n={3} /> Combined disease of the mitral and tricuspid valves is coded I08.1 in ICD-10; this code is included in the Russian Ministry of Health guideline on mitral stenosis.<Cite n={2} />

</Student>

## Symptoms

<Patient>

Mild stenosis causes no symptoms, and symptoms are usually mild overall.<Cite n={[3, 4]} />

Severe stenosis can cause an unpleasant fluttering feeling in the neck, tiredness and cold skin, because the heart pumps out little blood, and discomfort in the upper right part of the abdomen from an enlarged liver.<Cite n={[3, 4]} /> Palpitations (awareness of the heartbeat) may be felt.<Cite n={4} />

On examination, a doctor may notice strong pulsation and swelling of the neck veins, a darker or flushed face, and swelling (oedema).<Cite n={3} />

</Patient>

<Student>

According to MSD, the only symptoms of severe TS are fluttering discomfort in the neck (giant *a* waves in the jugular pulse), fatigue and cold skin (low cardiac output), and right upper quadrant abdominal discomfort (enlarged liver).<Cite n={3} /> The primary visible sign is a giant flickering *a* wave with gradual *y* descent in the jugular veins; jugular venous distension may increase with inspiration (Kussmaul sign); hepatic congestion and peripheral oedema may occur.<Cite n={3} />

On auscultation, TS is often inaudible but may produce a soft opening snap and a mid-diastolic rumble with presystolic accentuation. The murmur becomes louder and longer with manoeuvres that increase venous return (exercise, inspiration, leg raising, Müller manoeuvre) and softer and shorter with manoeuvres that decrease it (standing, Valsalva manoeuvre).<Cite n={3} /> Findings of TS often coexist with those of mitral stenosis and are less prominent.<Cite n={3} />

</Student>

## How it is diagnosed

<Patient>

The condition is suspected from the history and examination; a doctor may hear a characteristic murmur.<Cite n={[3, 4]} /> The diagnosis is confirmed by echocardiography (heart ultrasound) with Doppler. It shows the narrowed valve opening, thickened leaflets that move little, an enlarged right atrium and how much blood passes through the valve; it is used to determine how severe the stenosis is.<Cite n={[3, 4]} />

An ECG and a chest X-ray may show signs of an enlarged right atrium.<Cite n={[3, 4]} /> Blood tests may show raised liver enzymes because of blood congestion in the liver.<Cite n={3} /> Cardiac catheterisation is rarely needed to assess this condition.<Cite n={3} />

</Patient>

<Student>

The diagnosis is confirmed by Doppler echocardiography showing an elevated pressure gradient across the tricuspid valve; two-dimensional echocardiography shows thickened leaflets with reduced movement and RA enlargement.<Cite n={3} /> According to MSD, severe TS is a mean forward gradient across the valve of more than 5 mm Hg; MSD cites the 2020 ACC/AHA and 2021 ESC guidelines here.<Cite n={3} />

The ECG may show RA enlargement out of proportion to RV hypertrophy and tall, peaked P waves in the inferior leads and V1. The chest X-ray may show a dilated superior vena cava and RA enlargement (an enlarged right heart border).<Cite n={3} /> Catheterisation is rarely performed, for example to assess the coronary arteries; it then shows elevated RA pressure with a slow fall in early diastole and a diastolic gradient across the tricuspid valve.<Cite n={3} />

</Student>

## How it is treated

<Patient>

There is little evidence to guide the treatment of tricuspid stenosis.<Cite n={3} /> The condition is usually benign and needs no specific treatment, but people with symptoms may benefit from surgery.<Cite n={3} />

If there are symptoms and surgery is not being done, a doctor may advise eating less salt and prescribe diuretics (water tablets) and medicines that block the effects of the hormone aldosterone: they help lower the pressure in the veins.<Cite n={[3, 4]} /> Medicines are chosen by a doctor; do not start, stop or change treatment on your own.

The 2025 European guidelines recommend surgery for severe stenosis that causes symptoms, and for severe stenosis in people who are already having a procedure on the valves of the left side of the heart.<Cite n={[1, 3]} /> The main operation is replacement of the tricuspid valve with a prosthesis.<Cite n={1} /> Repair of the valve is usually avoided: the stenosis is rarely severe enough to need it, and the narrowing often comes back after repair.<Cite n={4} /> Whether surgery is needed, and which kind, is decided by the doctors together with the patient.

Tricuspid stenosis also matters in the treatment of mitral stenosis: a severe combination of tricuspid stenosis and regurgitation that needs surgery is one of the reasons not to widen the mitral valve with a balloon through a catheter.<Cite n={[1, 2]} /> More in the article on [mitral stenosis](../mitral-stenosis/).

</Patient>

<Student>

ESC 2025: surgery is recommended in symptomatic patients with severe TS (I C) and in patients with severe TS undergoing left-sided valve intervention (I C).<Cite n={1} /> Treatment of symptomatic TS mainly involves surgical tricuspid valve replacement.<Cite n={1} /> The role of transcatheter valve replacement in TS remains unexplored; the most efficient way to achieve ventricular pacing after tricuspid valve replacement still needs to be investigated.<Cite n={1} />

According to MSD, patients with symptoms who are not undergoing valve replacement or repair should receive a low-salt diet, diuretics and aldosterone antagonists; specific drugs and doses are not given here.<Cite n={3} /> Percutaneous balloon tricuspid commissurotomy might be considered for severe TS in patients who cannot undergo surgical repair, but only if there is no accompanying TR.<Cite n={3} />

Severe combined tricuspid stenosis and regurgitation requiring surgery is a contraindication to percutaneous mitral commissurotomy (catheter balloon valvuloplasty) in rheumatic MS.<Cite n={[1, 2]} />

</Student>

## When to call an ambulance

Tricuspid stenosis is usually benign, and its symptoms are usually mild.<Cite n={[3, 4]} /> But it can lead to the consequences of heart failure caused by right heart disease; congestion of blood in the liver and swelling may occur.<Cite n={3} /> When heart failure needs an ambulance is explained in the article on [heart failure](../heart-failure/). For the dangerous situations in mitral stenosis, which usually comes with this condition, see the article on [mitral stenosis](../mitral-stenosis/).

As with any heart disease, if you faint or have chest pain or severe shortness of breath, call your local emergency number (112 in the EU, 911 in the US and Canada, 999 in the UK) straight away: this is the site's general safety rule, and it is repeated at the bottom of every page.

<Quiz />