title: A novel technique for correction of severe tricuspid valve regurgitation due to complex lesions.
abstract: OBJECTIVE
  Correction of tricuspid regurgitation due to complex lesions (not treatable with annuloplasty only) is associated with suboptimal results. To improve the efficacy of valve repair in this context, we developed a new surgical approach, which consists of stitching together the central part of the free edges of the leaflets producing a 'clover' shaped valve. Our preliminary experience with this novel technique is reported.
  
  
  METHODS
  Between 2001 and 2003, 14 patients (mean age 57+/-17 years), with severe tricuspid regurgitation due to complex lesions, underwent valve repair with this novel approach in combination with annuloplasty. The aetiology of the disease was post-traumatic in five cases, degenerative in eight and secondary to dilated cardiomyopathy in one. Anterior leaflet prolapse/flail was present in most patients associated with posterior and/or septal leaflet prolapse or tethering. Annular and right ventricular dilatation was present in all cases. Mitral valve repair/replacement was concomitantly performed in nine patients.
  
  
  RESULTS
  Hospital mortality was 7.1% (1/14). At follow-up extending to 22 months (mean 12+/-6.3), all survivors were asymptomatic. At the last echocardiogram tricuspid regurgitation was absent or mild in 13 patients and moderate in one. Mean tricuspid valve area and gradient were 4.2+/-0.4 cm(2) and 2.7+/-1.4 mmHg, respectively.
  
  
  CONCLUSIONS
  Despite the short follow-up, this novel technique appears to be an easy, rapid and effective approach to correct severe tricuspid regurgitation due to complex lesions. Such a repair restored tricuspid valve competence, even in the presence of huge RV dilatation and pulmonary hypertension.
authors.affiliation: Department of Cardiac Surgery, San Raffaele University Hospital, Via Olgettina 60, 20132 Milan, Italy. michele.debonis@hsr.it
authors.forename: Michele
authors.initials: M
authors.lastname: De Bonis
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Lapenna
authors.forename: Giovanni
authors.initials: G
authors.lastname: La Canna
authors.forename: Antonio
authors.initials: A
authors.lastname: Grimaldi
authors.forename: Francesco
authors.initials: F
authors.lastname: Maisano
authors.forename: Lucia
authors.initials: L
authors.lastname: Torracca
authors.forename: Alessandro
authors.initials: A
authors.lastname: Caldarola
authors.forename: Ottavio
authors.initials: O
authors.lastname: Alfieri
mesh_terms: D000328:Adult; D000368:Aged; D004452:Echocardiography; D025401:Echocardiography, Stress; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000000981:diagnostic imaging; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D014949:Wounds, Nonpenetrating / Q000150:complications