ABSTRACT
The methods for repairing functional tricuspid regurgitation (TR) are still controversial. A novel concept of tricuspid annuloplasty for functional TR was developed. A flexible annuloplasty band, through which an expanded polytetrafluoroethylene (ePTFE) thread (CV3) was passed inside the cover cloth, was secured to the tricuspid annulus. Both ends of the ePTFE thread were passed through the right atrial wall. The thread was snared from outside the ejecting heart under observation by a transoesophageal echocardiogram after weaning off the cardiopulmonary bypass. We used this technique in 11 patients with functional TR (mean TR grade: 3.4 ± 0.8). The mean circumference of the annulus after snaring was 86.5 ± 4.6 mm (diameter 27.6 ± 1.5 mm). The postoperative TR at discharge was trivial or 0 in 9 patients and Grade 1 in 2. We concluded that this method has the potential to minimize residual regurgitation.
Subject(s)
Cardiac Valve Annuloplasty , Heart Valve Prosthesis Implantation , Tricuspid Valve Insufficiency/surgery , Tricuspid Valve/surgery , Aged , Aged, 80 and over , Cardiac Valve Annuloplasty/instrumentation , Echocardiography, Transesophageal , Female , Heart Valve Prosthesis , Heart Valve Prosthesis Implantation/instrumentation , Humans , Male , Polytetrafluoroethylene , Prosthesis Design , Severity of Illness Index , Suture Techniques , Treatment Outcome , Tricuspid Valve/diagnostic imaging , Tricuspid Valve/physiopathology , Tricuspid Valve Insufficiency/diagnosis , Tricuspid Valve Insufficiency/physiopathologyABSTRACT
A 74-year-old Japanese woman was referred to our hospital for surgical repair of an ascending aortic aneurysm and severe aortic valve regurgitation. She had received low dose steroid treatment for 6 years due to a diagnosis of the polymyalgia rheumatica (PMR), and no signs of inflammation were detected serologically. Modified reduction aortoplasty with external prosthetic support of the ascending aorta was performed following uneventful aortic valve replacement under cardiopulmonary bypass. The macroscopic view of the ascending aortic wall showed the diffuse spotty medial defects. The pathological interpretation of the aneurysmal wall was giant cell arteritis (GCA). Because PMR is intimately associated with GCA, physicians should be aware of the development of thoracic aortic aneurysm even in the course of PMR. Reduction aortoplasty is simple and may not be precluded from the treatment option for the aortic dilatation associated with giant cell arteritis.
