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Cusp commissuroplasty for tricuspid valve endocarditis.
Yoshiharu Hamanaka1, Norimasa Mitsui, Shinji Hirai
1Department of Thoracic and Cardiovascular Surgery, Hiroshima Prefectural Hospital, Hiroshima, Japan.
The Japanese Journal of Thoracic and Cardiovascular Surgery : Official Publication of the Japanese Association for Thoracic Surgery = Nihon Kyobu Geka Gakkai Zasshi
|December 3, 2003
Summary
A novel surgical technique reconstructed a damaged tricuspid valve in a young patient with severe heart failure. This innovative approach restored valve function, leading to a stable recovery without medication.
Area of Science:
- Cardiology
- Cardiac Surgery
- Infectious Diseases
Background:
- A 19-year-old woman presented with sepsis and heart failure.
- Blood cultures identified Streptococcus viridans, indicating infective endocarditis.
- Echocardiography revealed massive tricuspid valve vegetation and severe regurgitation.
Observation:
- Despite successful drug therapy for endocarditis, significant tricuspid valve damage persisted.
- Surgical intervention was necessary due to massive vegetation and severe regurgitation of the tricuspid valve.
- The anterior leaflet of the tricuspid valve was resected along with the vegetation.
Findings:
- A cusp commissuroplasty technique reconstructed the valve by approximating septal and posterior cusps.
- A single stitch created a zone of apposition, forming a unicommissural bicuspid valve.
- Autologous pericardium was used to patch a defect between the apposed leaflets and the tricuspid annulus.
Implications:
- This surgical reconstruction effectively restored tricuspid valve function.
- The patient remained stable for two years post-operation without requiring medical treatment.
- This case highlights a viable surgical option for complex tricuspid valve destruction in young patients.