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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
PubMed

Insights

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.

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