Repair of congenital tricuspid valve abnormalities with artificial chordae tendineae.
BACKGROUND
Congenital abnormalities of the tricuspid valve, including Ebstein's malformation, dysplasia, straddling, and those found in pulmonary atresia with intact septum and congenitally corrected transposition, are an uncommon cause of tricuspid regurgitation. Congenital tricuspid valve anomalies are found as a spectrum of disease in which both the leaflets and the subvalvar apparatus are often involved. Tricuspid valve repair is complicated in such patients because the chordae tendineae are often abnormally short and thick. Replacement or augmentation of chordae tendineae has proved to be a useful component of mitral valve repair. In the present report, we describe the techniques and results of chordal augmentation in the repair of congenital tricuspid valve abnormalities.


METHODS
Since July 1992, tricuspid valve repair has been performed in 5 children with severe tricuspid regurgitation secondary to congenital abnormalities of the tricuspid valve with significant chordal pathology. As a component of the repair, chordal replacement or augmentation was performed using expanded polytetrafluoroethylene suture.


RESULTS
Intraoperative and postoperative echocardiographic assessment showed good mobility of the tricuspid valve leaflets and trivial to mild tricuspid regurgitation. There were no complications and no early or late mortality. At follow-up of 34 to 60 months (median, 49 months), tricuspid valve function has remained excellent in 4 of the 5 patients. In the remaining patient, progressive regurgitation of the right ventricle to pulmonary artery allograft conduit has led to right ventricular dilatation, with a secondary increase in tricuspid regurgitation from trivial to moderate.


CONCLUSIONS
Chordal replacement or augmentation with expanded polytetrafluoroethylene suture is a useful technique in the repair of congenitally dysplastic tricuspid valves with abnormal chordal structures.
Division of Cardiothoracic Surgery, University of California at San Francisco, USA.
V M
VM
Reddy
D B
DB
McElhinney
M M
MM
Brook
N H
NH
Silverman
P
P
Stanger
F L
FL
Hanley
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002815:Chordae Tendineae / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000502:physiology / Q000601:surgery; D004108:Dilatation, Pathologic / Q000209:etiology; D018450:Disease Progression; D004437:Ebstein Anomaly / Q000601:surgery; D004452:Echocardiography; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000209:etiology; D006801:Humans; D007430:Intraoperative Care; D011138:Polytetrafluoroethylene; D019919:Prosthesis Implantation; D011651:Pulmonary Artery / Q000637:transplantation; D018633:Pulmonary Atresia / Q000150:complications; D013537:Sutures; D014184:Transplantation, Homologous; D014188:Transposition of Great Vessels / Q000150:complications; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000502:physiology / Q000601:surgery; D014262:Tricuspid Valve Insufficiency / Q000151:congenital / Q000503:physiopathology / Q000601:surgery; D018084:Ultrasonography, Interventional; D018497:Ventricular Dysfunction, Right / Q000209:etiology
D011138:Polytetrafluoroethylene