title: Cusp commissuroplasty for tricuspid valve endocarditis.
abstract: A 19-year-old woman with a history of drug addiction suffered from sepsis and heart failure. Blood culture was positive for Streptococcus viridans. An operation was indicated because the echocardiography showed massive vegetation on the anterior leaflet of the tricuspid valve and severe regurgitation even though the endocarditis was healed with drug therapy. At operation all of the anterior leaflet of the tricuspid valve was resected with the vegetation. Using the technique of cusp commissuroplasty, the disrupted commissure was reconstructed by approximating the septal and posterior cusps at the level of their normal closure, forming a zone of apposition by using a single stitch. Leaflet apposition resulted in a defect between the apposed leaflets and the tricuspid annulus, which was patched with autologous pericardium. The tricuspid valve was reconstructed to function as a unicommissural bicuspid valve. The patient was stable during the follow-up period of two years without any medical treatment.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Hiroshima Prefectural Hospital, Hiroshima, Japan.
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Hamanaka
authors.forename: Norimasa
authors.initials: N
authors.lastname: Mitsui
authors.forename: Shinji
authors.initials: S
authors.lastname: Hirai
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Isaka
authors.forename: Taira
authors.initials: T
authors.lastname: Kobayashi
mesh_terms: D000328:Adult; D013504:Cardiovascular Surgical Procedures / Q000379:methods; D004697:Endocarditis, Bacterial / Q000601:surgery*; D005260:Female; D006801:Humans; D013290:Streptococcal Infections / Q000601:surgery*; D014261:Tricuspid Valve / Q000601:surgery*; D034363:Viridans Streptococci