Abstract
BACKGROUND: Rheumatic tricuspid stenosis (TS) is a rare and easily missed clinical finding until late stages. Two-dimensional echocardiography (2DE) can assess the leaflet thickening and transvalvular gradients, which may be misleading in the presence of significant TR. Moreover, it lacks en face views of the tricuspid valve (TV), making the diagnosis of TS challenging. Meanwhile, three-dimensional echocardiography (3DE) effectively visualizes commissural fusion and sub-valvular thickening, enabling accurate tracing of the orifice area. CASE PRESENTATION: The authors present a case series discussing rheumatic and non-rheumatic TV stenosis to emphasize the role of 3DE in identifying the key findings in rheumatic stenotic TV and distinguishing them from other non-rheumatic etiologies. CONCLUSIONS: This case series demonstrated that 2DE has limitations in diagnosing TV stenosis, whereas 3DE provides a clear view of features such as commissural fusion and chordal thickening. Therefore, 3DE is essential in addition to 2DE for improved imaging of TV diseases, allowing accurate tracing of the orifice area, regardless of regurgitation.