Repair of flail leaflet of the tricuspid valve by a simple cusp remodeling technique.
OBJECTIVE
The approach of repairing tricuspid valve insufficiency caused by congenital lack of chordae or traumatic rupture of chordae is often complicated and difficult. We try to present an alternative method and midterm results.


METHODS
Between April 1997 and December 2004, eight patients (5 males, 3 females; mean age 23.9 +/- 5.8 years; range: 8 to 57 years) with severe tricuspid regurgitation (congenital lack of chordae in 5 cases and traumatic rupture of chordae in 3 cases) underwent surgical repair at Fu Wai Hospital. Four patients were in NYHA (New York Heart Association) class III, and 4 in class IV. Eight flail anterior leaflets and one flail septal leaflet of the tricuspid valve with massive tricuspid regurgitation were identified by echocardiography and the spaces of the free edges of the flail leaflets ranged from 20 to 30 mm. Tricuspid repair was performed under hypothermic cardiopulmonary bypass. The free edge of the affected cusp segment was sutured in folio, the segment of annulus devoid of leaflet was plicated, and the neo-annulus was fixed with a flexible annuloplasty ring.


RESULTS
All patients survived and recovered after the operation. Echocardiography showed good coaptation with no regurgitation of the tricuspid valve in five patients and a mild residual tricuspid regurgitation in three patients. A remarkable decrease in the diameter of the right ventricle was observed, from a mean of 42.6 +/- 12.5 mm to a mean of 23.6 +/- 5.3mm (p < 0.01). Mean follow up was 50 +/- 42.9 months. Six patients were in NYHA class I, and two in class II and III. Except for one patient who had a mild-to-moderate increase in tricuspid regurgitation a year later, all the other patients were doing well.


CONCLUSIONS
The procedure provided a simple and valuable option for repair of flail leaflet of tricuspid valve caused by congenital lack of chordae or traumatic rupture of chordae.
Department of Cardiovascular Surgery, Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic China. xiubinyang@yahoo.com
Xiubin
X
Yang
Qingyu
Q
Wu
Jianping
J
Xu
Xiangdong
X
Shen
Shuang
S
Gao
Feng
F
Liu
D000293:Adolescent; D000328:Adult; D002315:Cardiopulmonary Bypass; D002648:Child; D002815:Chordae Tendineae / Q000002:abnormalities / Q000293:injuries; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D017380:Hypertrophy, Right Ventricular / Q000000981:diagnostic imaging / Q000601:surgery; D007036:Hypothermia, Induced; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D012008:Recurrence; D013536:Suture Techniques; D014261:Tricuspid Valve / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery*; D014262:Tricuspid Valve Insufficiency / Q000151:congenital* / Q000000981:diagnostic imaging / Q000601:surgery*