Absence of posterior tricuspid valve leaflet and valve reconstruction

Abstract

We report a rare case of the absence of a posterior tricuspid valve leaflet. A male patient, aged 46, suffering from severe tricuspid valve regurgitation (TR) of unknown aetiology and atrial septal aneurysm was referred to our hospital for surgery. On surgical inspection, the posterior tricuspid valve leaflet and its subvalvular apparatus were completely absent and only the valve annulus was seen in the corresponding position. The anterior and septal leaflets were normal. We successfully reconstructed the tricuspid valve as follows: the head of an anterior papillary muscle was approximated to the ventricular septum (Sebening stitch). After the approximation of the centre of the tricuspid annulus of the anterior leaflet to the tricuspid annulus on the opposite side, a sizer of 29 mm in diameter was easily passed through the anterior orifice. The posterior orifice was closed with running sutures (posterior annulorrhaphy after Hetzer). Before these procedures, we attempted to reconstruct the tricuspid valve with a posterior annulorrhaphy alone; however, valve competence was insufficient. A Sebening stitch was necessary to improve the valve competence. Echocardiography showed TR grade 1 at the patient's discharge from hospital and TR grade 1 to 2 at the follow-up, 10 months after the operation.

Hypoplastic Posterior Leaflet of the Tricuspid Valve—a Unique Cause of Right Heart Failure

“…There have only been 5 cases in total of congenital absence of TV leaflets reported. 3 , 4 Of these, 2 involved the anterior leaflet, with the remaining 3 involving the posterior leaflet. Differentiating complete absence, versus hypoplasia, may be important to guide direction of care, as complete absence of leaflets may preclude patients from surgical repair or procedures involving transcatheter edge-to-edge repair.…”

Tricuspid valve agenesis: a case report of a rare cause of tricuspid regurgitation in an adult

“…With regard to the surgical options in patients with TV agenesia, the existing data are obtained from isolated case reports. Komoda et al 13 reported a successful repair using a combination of posterior annulorrhaphy and Sebening stitch to reduce the regurgitant orifice. However, in the small number of case reports available, valve replacement was favoured.…”

Tricuspid valve repair with papillary muscle approximation for congenital tricuspid valve regurgitation due to tricuspid valve dysplasia

“…Sebening stitch 6 is the other reparative technique at the subvalvular apparatus. In this technique, sutures of the anterior papillary muscle are placed at the head.…”