Totally endoscopic three-dimensional tricuspid valve repair in an adult with Ebstein's anomaly

We report the case of a 52-year-old woman with severe tricuspid regurgitation due to Ebstein's anomaly. She underwent surgery through a 2.5 cm right minithoracotomy incision under three-dimensional endoscopic visualization. After identification of the atrialized right ventricle and the displaced attachments of the septal leaflet and part of the posterior leaflet within the atrialized segment, plication of the atrialized portion was performed to exclude it. The displaced leaflet attachment level within the atrialized right ventricle was regarded as the functional tricuspid annulus and served as the site for annuloplasty. Tricuspid annuloplasty was then performed using a semi-rigid partial ring, and leaflet coaptation was further improved by an edge-to-edge valvuloplasty. Postoperative echocardiography showed trace tricuspid regurgitation, and computed tomography demonstrated resolution of the atrialized right ventricle. She was discharged home in good condition.