Pericardial Patch And Neochords For The Totally Endoscopic Reconstruction Of Tricuspid Valve Endocarditis.
Antonios Pitsis, Head of Cardiac Surgery.
European Interbalkan Medical Center, Thessaloniki, Greece.
BACKGROUND: Tricuspid valve repair seems to be associated with better short- and long-term outcomes, compared to replacement.METHODS: A 60 y.o. man with a one month history of infective endocarditis of the tricuspid valve, positive cultures of Strep. pyogenes, septic pulmonary emboli and severe tricuspid regurgitation with large vegetations was referred for surgical treatment. He underwent an urgent totally endoscopic procedure, through a periareolar working incision. On the beating heart the tricuspid valve was evaluated and extensive damage was confirmed. The heart was arrested with del Nido cardioplegic solution and an extensive debridement of the affected tricuspid leaflets was performed. The anterior and posterior leaflets were left with a large deficit of tissue. A bovine pericardial patch, size 5 x 2 cm, was used to create a common anteroposterior leaflet, which was supported with a set of 4 loops of 22mm in length, anchored in the anterior tricuspid papillary muscle. The reconstruction was completed with an undersized annuloplasty with a size 31 mm flexible annuloplasty band.
RESULTS: Post CPB TOE showed a competent tricuspid valve wit trivial tricuspid regurgitation and a mean gradient of 1,5 mmHG.The patient was extubated on the 1st postop day and returned to the general ward on the 2nd.
CONCLUSIONS: Even heavily destroyed tricuspid valves can be reconstructed with various surgical techniques through a minimally invasive approach.
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