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Ring Dehiscence From Right Fibrous Trigone Misidentification
Takahide Yoshio1, Yoshito Ito2, Kota Suzuki2
1Department of Cardiac Surgery, Kawasaki Saiwai Hospital, Kawasaki, Japan.
Background:
Accurate identification of the right fibrous trigone is essential for durable mitral annuloplasty. Misidentification may lead to annuloplasty ring malposition and early ring dehiscence.
Case Summary:
A 24-year-old man with severe mitral regurgitation due to medial P2-P3 billowing underwent minimally invasive mitral valve repair with implantation of a 34-mm annuloplasty ring. On postoperative day 12, transesophageal echocardiography revealed ring dehiscence at the right fibrous trigone despite preserved valve competence. Reoperation confirmed incomplete trigonal engagement, and the ring was replaced with secure anterior extension of sutures. The postoperative course was uneventful.
Discussion:
This case illustrates an uncommon mechanism of ring dehiscence, misidentification of the right fibrous trigone, highlighting the importance of anatomical orientation and tactile feedback during annuloplasty.
Take-Home Message:
Secure trigonal engagement is critical to prevent ring malposition and dehiscence.
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