Pericardial patch augmentation with partial ring annuloplasty for rheumatic tricuspid regurgitation

Tricuspid regurgitation, associated with poor functional status and reduced survival, is common in patients with rheumatic heart disease after left-sided valve replacement. Although repair is preferred over replacement, surgical repair remains technically challenging. A 60-year-old woman presented with recurrent bilateral leg oedema for 2 years and dizziness with palpitations for 2 months. She had undergone mechanical mitral and aortic valve replacement 18 years earlier for rheumatic heart disease. Echocardiography demonstrated severe central tricuspid regurgitation with preserved prosthetic valve function and atrial arrhythmia. Via median sternotomy and cardiopulmonary bypass, classic rheumatic pathology of the tricuspid valve was identified. Repair consisted of detachment of the anterior and posterior leaflets, augmentation with an annuloplasty-shaped bovine pericardial patch to increase leaflet height and coaptation, and implantation of a partial rigid annuloplasty ring slightly smaller than the patch. Intra-operative echocardiography showed trace residual tricuspid regurgitation. Recovery was uneventful, with early resolution of oedema. Leaflet augmentation combined with partial ring annuloplasty is a simple and reproducible technique that restores early valve competence in complex rheumatic tricuspid regurgitation. Long-term follow-up is required to confirm durability.