Mitral and tricuspid valve disease

Mitral stenosis (MS) has become less common in developed countries with the declining incidence of rheumatic fever but remains a major health problem worldwide. Atrial fibrillation is a common accompaniment and can trigger the onset of pulmonary oedema. Medical treatment aims to control atrial fibrillation and prevent thromboembolism. Patients with symptoms and a valve area ≤1.5 cm2 should be considered for balloon valvuloplasty or surgical valve replacement. Mitral regurgitation (MR) is common and usually caused by degenerative disease of the valve or is secondary to underlying left ventricular dysfunction. Management depends on the aetiology. Patients with severe degenerative MR should be offered valve repair before the onset of limiting symptoms or left ventricular dysfunction. Exercise testing can have a role in surveillance and decision-making. Surgery for ischaemic MR is less successful but should be considered in patients with severe MR undergoing coronary artery bypass grafting, and in carefully selected patients with severe MR and symptoms of breathlessness despite optimal medical therapy. Percutaneous and minimally invasive approaches are emerging as alternatives in some patients. Tricuspid regurgitation is commonly seen on echocardiography and, if moderate to severe, is associated with a poor prognosis.