Complex Tricuspid Valve Repair
In this video, the authors demonstrate the step-by-step approach to
perform septal leaflet augmentation and several neochordae that allowed
for effective correction of severe tricuspid regurgitation with annular
dilation and complex tethering of valve leaflets.
A 43-year-old man was referred to the authors’ department for severe isolated tricuspid regurgitation. He presented with dizziness without syncopial episodes or overt dyspnoea (NYHA I). He was found to have torrential TR with moderate RV dysfunction and mild LV dysfunction. He had a normal angiogram. On TOE, there was a dilated TV annulus (6.3 cm) with dilated RV (midcavity RV dimension 6.0 cm), severe prolapse of anterior leaflet with abnormal thickened chordae, and restriction of the septal leaflet, resulting in noncoaptation of the leaflets. There was no clear etiology, so it could have been congenital, but he does give a history of a high fall 4-5 months before operation.
horizontal right atriotomy was performed. The ring stitches were placed
first to expose the valve. The commissure between the posterior and
septal leaflets was oversewn with running 5-0 prolene. The septal
leaflet was detached from the annulus and a cardiocel neo patch was
sutured with 5-0 prolene to extend the leaflet. A couple of tethering
septal chordae were removed and replaced with CV4 Goretex sutures. The
thickened and fused chordae of the anterior leaflet was reduced in
length by folding it and securing it with 4-0 prolene. X3 CV4 were
positioned in thickened areas of the RV, and then positioned
symmetrically onto the anterior leaflet. A 32 mm tricuspid physio ring
was positioned with interrupted 2-0 ethibond sutures. The operation was
completed in a usual fashion. Intraoperative TOE showed a good result
with trace regurgitation. The patient went home on the fifth
postoperative day without complications. Routine follow-up was
satisfactory with trace TR and improving RV dimension and function
(midcavity diameter 5.2 cm) on echocardiography.