How to do it
Tricuspid Valve Repair With Neopapillary Muscle From Right Ventricular Trabecula

https://doi.org/10.1016/j.athoracsur.2009.08.059Get rights and content

Congenital abnormalities of the tricuspid valve without downward displacement of the septal and posterior tricuspid leaflets are uncommon causes of tricuspid regurgitation. Progressive tricuspid regurgitation can lead to right heart dilatation, arrhythmia, and irreversible deterioration of right ventricular function. Tricuspid valve repair is an important method to stabilize symptomatic children because tricuspid valve replacement has a poor prognosis. We report the successful use of right ventricular trabecula as a “neopapillary muscle” for treating severe low-pressure tricuspid regurgitation in children.

Section snippets

Technique

After a median sternotomy, total cardiopulmonary bypass was established between the ascending aorta and both vena cavae. On a beating heart, the right atrium was opened parallel to the atrioventricular groove, and the foramen ovale was closed under a well of saline. The tricuspid valve showed prolapse of the anterior leaflet without chordal rupture. The midpart of the anterior tricuspid leaflet (ATL) was unsupported. The septal and posterior leaflets were normal.

At this stage, a thick

Comment

Apart from the Ebstein anomaly, congenital abnormalities of the tricuspid valve causing TR are uncommon. Primary tricuspid valve lesions need to be fully and meticulously assessed in the same way as the mitral valve and addressed accordingly. In case of prolapse of the leaflet/leaflets, resection of the flail segment is advised and if a perforation of the leaflet is found to be the cause of regurgitation, selective closure with native pericardium suffices. A commissural leak similarly may be

References (7)

There are more references available in the full text version of this article.
View full text
Copyright © 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.