The Journal of Thoracic and Cardiovascular Surgery, Vol 94, 626-631, Copyright © 1987 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
New developments for reconstruction of the tricuspid valve
C Minale, H Lambertz and BJ Messmer
Department of Thoracic and Cardiovascular Surgery, University Hospital of R.W.T.H. Aachen, Federal Republic of Germany.
Four patients with multivalvular disease underwent tricuspid valve repair
by a new technique. The anterior and posterior leaflets adjacent to the
incompetent commissure were separated from the anulus to allow coaptation
of the three leaflets in the middle. In conjunction with the commissure,
half of the isolated anulus was then excluded with a continuous 3-0 Ti-Cron
suture. A 5-0 Prolene suture was then used to readapt the cut edges of the
leaflets to the shortened anulus. In this way it was possible to reduce the
circumference of the anulus selectively, without reducing the active area
of the leaflets. All patients survived. A significant decrease in the mean
right atrial pressure without evidence of regurgitation could be recorded
in all patients. Postoperative morphometric echocardiographic evaluation of
the tricuspid valve showed a maximal anulus diameter even larger than in
normal hearts. No inflow obstruction was present. The systolic shortening
of the anulus ranged within normal limits. The opening amplitude of the
leaflet as well as the slope of the ejection fraction were not decreased.
No significant regurgitation was evidenced by contrast echocardiograms. One
to 3 months postoperatively, no annuloplasty dehiscence has occurred.
