How to do the double orifice valve technique to treat tricuspid valve incompetence

A straightforward tricuspid valve repair technique is illustrated here, which may be employed either for functional (normal valve with dilated annulus) or for primary or organic (Ebstein's anomaly, leaflet retraction/tethering and chordal malposition/tethering, with annular dilatation) tricuspid valve incompetence and for moderate and severe degrees of incompetence, without any residual regurgitation or reoperation. The basic principle is to reduce the distance between the coapting leaflets in a manner in which the most mobile leaflet, which is usually the anterior, could coapt to the opposite leaflet, by creating two orifices, ensuring valve competence. Additionally, it reduces annular dilatation and lessens tricuspid valve leaflet tethering, thereby stabilizing the annulus and increasing leaflet coaptation.