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Tricuspid and pulmonary valve disease

Considerations

Tricuspid stenosis is most commonly associated with rheumatic fever but may be caused by other conditions. In the case of rheumatic fever it is invariably associated with involvement of the left sided valves. Tricuspid stenosis results in right atrial hypertension and elevated systemic venous pressure with associated pulsations in the neck veins and peripheral oedema. It may be protective of the pulmonary vascular bed if there is co-existing mitral stenosis. The diastolic heart murmur, best heard along the left low sternal border, increases with inspiration. The ECG may show tall, tented shape, P waves.

Tricuspid regurgitation is most commonly secondary to right ventricular dilatation and hypertrophy. The jugular veins will display large waves. The murmur is holosystolic and best heard over the left sternal edge, during inspiration. AF is often present with little else showing on the ECG. Tricuspid regurgitation results in hepatic congestion and peripheral oedema.

Pulmonary valve stenosis is most commonly the result of congenital heart disease. See subchapter 3.1.26.

Pulmonary valve regurgitation is commonly caused by pulmonary hypertension, itself secondary to mitral stenosis, pulmonary thrombus or chronic lung disease. The murmur is diastolic and high pitched and best heard along the left sternal border.

Information to be provided

  • Information relating to any associated cardiac condition as outlined in this chapter;
  • Cardiologist report on the first occasion that an applicant presents with a murmur, other than a faint typical flow murmur in a young applicant, or with a history of pulmonary or tricuspid valve disease;
  • Echocardiogram;
  • Other tests such as stress ECG, as recommended by the investigating cardiologist or CAA;
  • Subsequent recurrent reports and investigations as advised by the investigating cardiologist or CAA.

Disposition

  • An applicant with a history of Tricuspid or Pulmonary valve disease should generally be considered as having a condition that is of aeromedical significance.
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