[Tricuspid annuloplasty]

Isolated tricuspid valve disease is rare. In approximately 75% of the cases, the tricuspid regurgitation (TR) is caused by dilatation of right ventricle, tricuspid annulus, and pulmonary hypertension. The presence of TR associated with left-sided valve disease, especially mitral, is very common. According to ACC/AHA 2006 Guidelines for the management of patients with valvular heart disease, severe TR should be treated during operations for multivalvular disease (class I, level of evidence : C). Tricuspid annuloplasty is indicated even for mild TR in patients undergoing mitral valve surgery when there is pulmonary hypertension or tricuspid annular dilatation (class IIa, level of evidence : C). Techniques to deal with a dilated tricuspid valve annulus with normal leaflets and chordal structures include placation of the posterior leaflet annulus (bicuspidization), semicircular purse-string reduction of the anterior and posterior leaflet annuli (DeVega technique), and rigid or flexible rings or bands placed to reduce the annular size and achieve leaflet coaptation. The procedure is easy and safe. However, further studies are mandatory in cases of mild functuional TR to achieve better long-term outcome in patients with mitral valve disease undergoing mitral valve surgery.