Mitral Stenosis

Mitral stenosis is a disease of the mitral valve involving the narrowing of the valve. The vast majority of mitral stenosis cases are caused by heart disease secondary to rheumatic fever and rheumatic heart disease. Far less common causes include calcification of the mitral valve leaflets, or congenital heart disease.

Signs and symptoms

Symptoms of mitral stenosis include:

  • Symptoms of heart failure:
    • Breathlessness during exercise or exertion
    • Shortness of breath while lying flat,
    • Severe nighttime shortness of breath and coughing, often waking the patient from sleep
  • Palpitations
  • Chest pain
  • Coughing up blood or bloody phlegm
  • Blood clots
  • Accumulation of fluid in the lungs, abdomen, or swelling in the legs
  • Symptoms that increase with exercise and pregnancy can include fatigue and weakness.


Treatment for mitral stenosis may not be necessary in patients who do not experience symptoms. Options include medical management, mitral valve replacement, and balloon dilatation.

The Tricuspid Valve

The tricuspid valve is positioned on the right side of the heart between the right ventricle and the right atrium. Most tricuspid disease develops secondarily to left-sided heart disease or failure.

Primary tricuspid disease – without prior left sided heart disease is less common. Therefore, most surgical treatment of the tricuspid valve occurs concomitantly with mitral valve, aortic valve, or coronary artery bypass operation.

Tricuspid Insufficiency

Tricuspid insufficiency is a valvular heart disease (sometimes referred to as “tricuspid regurgitation”). It is the failure of the heart’s tricuspid valve to close properly during heartbeats. When tricuspid insufficieny occurs, each heartbeat passes some blood from the right ventricle to the right atrium, this is the opposite of the normal direction of blood flow. Tricuspid insufficiency is rare and occurs in approximately less than 1% of people. Most people with the condition do not experience any symptoms.

Signs and symptoms

Although most patients with tricuspid insufficiency are asymptomatic, some may experience symptoms similar to those of right-sided heart failure, which include:

  • Accumulation of fluid in the abdomen, or swelling of the legs
  • Enlargement of the liver
  • Jugular venous distension
  • Vague upper abdominal discomfort from a congested liver
  • Fatigue due to diminished cardiac output


Most cases of tricuspid insufficiency are caused by dilation of the right ventricle. There are number of diseases which can have a direct effect on the tricuspid valve. Most common is rheumatic fever. Another condition that harms the tricuspid valve is endocarditis. Endocarditis is often infectious in nature and commonly associated with IV drug abuse. Although, with progressive or sustained right-side heart failure, TR is very common. This valvular disease often goes unnoticed until symptoms are very bad.

Less frequent causes of tricuspid insufficiency include:

  • Carcinoid tumors
  • Connective tissue diseases such as Marfan syndrome
  • Systemic lupus erythematosus
  • Myxomatous degeneration
  • Injury
  • Rheumatoid arthritis
  • Radiation therapy
  • Use of diet medications including phentermine and fenfluramine or dexfenfluramine
  • Congenital defects