Document Detail


Repair of flail leaflet of the tricuspid valve by a simple cusp remodeling technique.
MedLine Citation:
PMID:  17661778     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND AIM: 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. CONCLUSION: 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.
Authors:
Xiubin Yang; Qingyu Wu; Jianping Xu; Xiangdong Shen; Shuang Gao; Feng Liu
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of cardiac surgery     Volume:  22     ISSN:  0886-0440     ISO Abbreviation:  J Card Surg     Publication Date:    2007 Jul-Aug
Date Detail:
Created Date:  2007-07-30     Completed Date:  2007-09-17     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8908809     Medline TA:  J Card Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  333-5     Citation Subset:  IM    
Affiliation:
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
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Cardiopulmonary Bypass
Child
Chordae Tendineae / abnormalities,  injuries
Echocardiography
Female
Follow-Up Studies
Heart Failure / surgery,  ultrasonography
Humans
Hypertrophy, Right Ventricular / surgery,  ultrasonography
Hypothermia, Induced
Male
Middle Aged
Postoperative Complications / ultrasonography
Recurrence
Suture Techniques
Tricuspid Valve / abnormalities*,  surgery*,  ultrasonography
Tricuspid Valve Insufficiency / congenital*,  surgery*,  ultrasonography

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