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Equine pericardium and chordae autotransplantation to reconstruct Tricuspid Valve anterior leaflet in massive endocarditis
Gabriele Di Giammarco, MD, Carlo Canosa, MD, Massimiliano Foschi, MD, Daniele Marinelli, MD, Michele Di Mauro, MD, Donato Micucci, MD.
University "G.D'Annunzio", Chieti, Italy.

Tricuspid valve in drug users is one of the most frequent localization of right-sided endocarditis.The objective should be the preservation of the valve, whenever possible, minimizing use of artificial components in the aim to reduce the risk of recurrences.Here following we describe an original technique for tricuspid valve preservation in infective endocarditis.
A 44 year-old male with history of intravenous drug abuse was referred to our Unit with a diagnosis of Staphilococcus Aureus tricuspid valve endocarditis with a large vegetation on anterior leaflet (cm 1,9 X 1) covering a large perforation in a history of recent pulmonary embolism.
The patient was operated through a median sternotomy. Ascending aorta and bicaval cannulation were used for cardiopulmonary bypass (CPB). The inspection of the valve showed a large vegetation on anterior leaflet of the tricuspid valve along with its extensive destruction. The anterior leaflet was resected on normal tissue along a line 2mm far from the annular attachement. A sheet of equine pericardium was then sutured along this line using a 5/0 polipropilene.Native chordae that were not involved in the process were reimplanted on the neo-leaflet free edge within the two commissures. The intraventricular saline injection demonstrated valve competence.The valve repair was stabilized with the use of an annuloplasty ring.Intraoperative echocardiographic control confirmed the valve competence.The patient was easily weaned from CPB.The postoperative course was uneventful. Postoperative echocardiography in day 4th postoperative day showed a trivial tricuspid regurgitation with no signs of valve stenosis.The patient was discharged asymptomatic in 11th postoperative day.
This is the first time the technique used is described.In addition, native chordae preservation makes the leaflet reconstruction easier without the risk of rupture of tiny papillary muscles supporting tricuspid valve.
Figure 1. A: Pericardium patch trimmed to right dimension; B: suture of pericardium patch to tricuspid anterior leaflet annulus; C: Suture of the free edge of pericardium patch to native chordae tendinae; D: final view of tricuspid valve after reconstruction

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