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Surgical Reconstruction of the Tricuspid Valve for Acquired Severe Stenosis

  • M. Cotrufo
  • R. Bellitti
  • D. Casale
  • T. S. L. De Luca
  • P. Santé
  • A. d’Angelo
  • B. Giannolo
  • S. Iesu
  • V. Mazzei
Conference paper

Abstract

From 1975 through 1987, 63 patients were treated by conservative surgery for severe rheumatic tricuspid stenosis; 82% were females, 18% males. Ages ranged from 20 to 67 years (mean: 40.2); 78% were in NYHA class III, 22% in class IV. In 34 patients (54%) tricuspid stenosis was associated to mitral valve disease and in 29 patients (46%) to mitral and aortic valve disease. The stenotic tricuspid valve was never found to be calcified. The surgical reconstruction was achieved by anteroseptal and posteroseptal commissurotomy associated with De Vega’s annuloplasty in 62 patients and with implantation of a Carpentier ring in one patient. The operative procedure used transforms the tricuspid valve into a bicuspid one with a wide anterior leaflet; the valvular area reaches normal size according to sex and body surface. Hemodynamically tested valve continence was satisfactory in all patients. Hospital mortality was 12.6%: three patients died in the group with mitral and tricuspid valve disease, and five in the group with mitral, aortic, and tricuspid valve disease. The postoperative Two-dimensional Doppler echocardiographic study never showed significant recurrent tricuspid stenosis, but a late development of tricuspid regurgitation, severe in four patients, mild in eight. Not one of the survivors had to be reoperated for tricuspid valve disease. The authors emphasize that the conservative treatment of severe tricuspid stenosis has undoubtedly some advantages if compared to replacement when the high operative mortality reported in the literature and the complications related to the valvular prostheses are considered. Furthermore, the late tricuspid regurgitation, mild or severe, cannot be considered residual to the conservative procedure, but due to the progressing annular dilatation which usually develops in patients with a preoperatively dilated (3.5 cm) right ventricle.

Keywords

Tricuspid Valve Valve Disease NYHA Class Mitral Valve Disease Aortic Valve Disease 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Boskovic D, Elezovic I, Boskovic D, Simin N, Rolovic Z, Josipovic V (1986) Late thrombosis of the Björk-Shiley tilting disc valve in the tricuspid position. Thrombolytic treatment with streptokinase. J Thorac Cardiovasc Surg 91: 1–8PubMedGoogle Scholar
  2. 2.
    Beeuwsaert R, Denef B, De Geest H (1983) Diagnosis and treatment of obstruction of a tricuspid Björk-Shiley prosthesis. Acta Cardiol (Brux) 1: 13–25Google Scholar
  3. 3.
    Tornburn CW, Morgan JJ, Shanahan MX, Chang VP (1983) Long-term results of tricuspid valve replacement and the problem of prosthetic valve thrombosis. Am J Cardiol 51: 1128–1132CrossRefGoogle Scholar
  4. 4.
    Wellens F, Van Dale P, Deuvaert FE, Leclerc JL, Primo G (1982) The role of porcine heterografts in a 14-years experience with tricuspid valve replacement. In: Cohn LH, Gallucci V (eds) Cardiac bioprostheses, proceedings of the second international symposium. Yorke Medical Books, New York, pp 502–515Google Scholar
  5. 5.
    Edmunds LH Jr (1982) Thromboembolic complications of current cardiac valvular prostheses. Ann Thorac Surg 34: 96CrossRefPubMedGoogle Scholar
  6. 6.
    Brugger JJ, Egloff L, Rothlin M (1982) Tricuspid annuloplasty: results and complications. Thorac Cardiovasc Surg 30: 284CrossRefPubMedGoogle Scholar
  7. 7.
    Chidambaram M, Abdulali SA, Ganesh Baliga B, Ionescu MI (1987) Long-term results of De Vega tricuspid annuloplasty. Ann Thorac Surg 43: 185–188CrossRefPubMedGoogle Scholar
  8. 8.
    Cotrufo M, Caruso A, Bellitti R, Scardone M, De Luca TSL, Renzulli A (1984) La correzione chirurgica della stenosi tricuspidale organica con tecnica conservativa. Minerva Cardioangiol 32: 823–829PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1989

Authors and Affiliations

  • M. Cotrufo
    • 1
  • R. Bellitti
  • D. Casale
  • T. S. L. De Luca
  • P. Santé
  • A. d’Angelo
  • B. Giannolo
  • S. Iesu
  • V. Mazzei
  1. 1.Medical and Surgical Institute of Cardiology, 1st School of MedicineUniversity of Naples, Ospedale V. Monaldi, Via L. BianchiNaplesItaly

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