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Updated: Jun 2, 2026
Aortic Ring Assay
Published on: November 24, 2009
A biodegradable ring enables growth of the native tricuspid annulus
Wojciech Mrowczynski1, Bartlomiej Mrozinski, Afksendiyos Kalangos
1Department of Pediatric Cardiac Surgery, Poznan University of Medical Sciences, Poznan, Poland. wjmrow@amp.edu.pl
Insights
Biodegradable annuloplasty rings allow the tricuspid valve annulus to grow with children, maintaining valve function. This repair method supports somatic growth without negatively impacting the repaired valve.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Biomaterials Science
Background:
- Severe congenital tricuspid valve regurgitation often requires surgical intervention in children.
- Annuloplasty using intra-annular rings is a common repair technique.
- Assessing the long-term growth potential of the tricuspid valve annulus post-repair is crucial for pediatric patients.
Purpose of the Study:
- To evaluate the growth and functional capacity of the tricuspid valve annulus after annuloplasty with a biodegradable ring.
- To determine if the biodegradable ring impedes native valve annulus growth in pediatric patients.
Main Methods:
- Retrospective analysis of 11 children (median age 4.5 years) who underwent tricuspid valve repair with a biodegradable annuloplasty ring.
- Regular transthoracic echocardiography to monitor tricuspid valve annulus lateral diameter (TVALD) and valve function.
- Growth rates derived from regression analysis correlating TVALD with body surface area (BSA).
Main Results:
- The TVALD significantly increased post-surgery, demonstrating harmonious somatic growth.
- A positive correlation between TVALD and lnBSA was observed in 63.6% of patients.
- Tricuspid valve insufficiency and pressure gradients remained stable, indicating preserved valve function.
Conclusions:
- Biodegradable annuloplasty rings do not restrict tricuspid valve annulus growth in children.
- The repaired annulus demonstrated proportional growth with somatic development.
- Valve function was maintained, with no adverse effects from annulus growth over time.
Background And Aim Of The Study:
The study aim was to assess the growth potential and function of the tricuspid valve (TV) annulus after annuloplasty with the intra-annular biodegradable ring.
Methods:
Among 11 children (median age 4.5 years; age range: 0.2-10.9 years) who underwent surgery for severe congenital TV regurgitation, valve repair was completed using a biodegradable annuloplasty ring. The children were followed regularly using transthoracic echocardiography, whereby the TV annulus lateral diameter (TVALD) and valve function were monitored. Rates of valve growth were derived from the slope of the regression equations which related TVALD to the natural logarithm of the body surface area (lnBSA).
Results:
The children's somatic growth was harmonious throughout the entire follow up period (mean 478 days; range: 171-1,477 days). The TVALD differed significantly at six months and at one and two years after surgery compared to the postoperative value at discharge, rising from 19 mm (range: 15.5-26.0 mm) to 24 mm (range: 19.0-30.0 mm) at the last control examination (p = 0.003), while the related Z-scores remained stable. A significant linear correlation between TVALD and lnBSA was found in 63.6% of patients. The median rate of growth for the whole cohort was 1.96-fold (range: 0.52-5.53-fold) higher than a norm, and correlated strongly and positively with age (r = 0.91; p <0.05). The median postoperative TV insufficiency fraction of 9.8% (range: 0-28.8%) remained constant during the follow up period. The postoperative TV maximal pressure gradient was 5.5 mmHg (range: 3.1-12.2 mmHg), and did not increase over time.
Conclusion:
The implantation of a biodegradable ring does not restrict growth of the native TV annulus; this enabled its stabilization in proportion to the somatic growth in the majority of the children. The TV annulus began to change its dimension at six months postoperatively, which may coincide with its biodegradation. The rate of growth of the TV annulus differed from that in the normal population, and was proportional to the patient age. The increase in TV annulus diameter over time did not have any negative influence on the function of the repaired valve.
