Surgical Reconstruction of the Tricuspid Valve for Acquired Severe Stenosis

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.