Repair of Congenitally Absent Chordae in a Tricuspid Valve Leaflet with Hypoplastic Papillary Muscle Using Artificial Chordae

Abstract

Isolated congenital tricuspid regurgitation without downward displacement of the leaflet is uncommon in adults, and repair of such valves often requires a procedure that is more complex than simple tricuspid annuloplasty. We describe a technique of tricuspid valvoplasty using the neo-papillary loop technique to reconstruct multiple artificial chords for isolated congenital tricuspid regurgitation associated with a dysplastic anterior leaflet with agenesis of the chordae tendineae and a hypoplastic anterior papillary muscle. This technique provides a simple and valuable option for the repair of dysplastic valves lacking chordae, even those with a hypoplastic papillary muscle.

Three-Dimensional Echocardiography Reveals Extensive Congenital Anterior Tricuspid Valve Prolapse

“…The first case was of congenitally absent chordae in the anterior TV leaflet with hypoplastic papillary muscle. 14 The second case was of the congenital absence of anterior papillary muscle of the TV. 15 These case reports stated that 2D TTE was used for preoperative evaluation; however, a detailed evaluation using 3D TEE was not reported.…”

Artificial Neochordae for Tricuspid Valve Repair in Adults: A Review

“…Case Reports ePTFE neochordae were used in six adult patients, four females and two males aged 23 to 79 years, with congenital heart malformations [46][47][48][49][50][51] (►Table 3). TR was due to dilatation of the tricuspid annulus in one, 46 absence of chordae tendineae to the anterior leaflet in one, 47 agenesis of the anterior papillary muscle in one, 50 and cleft of the anterior leaflet in one.…”

“…Case Reports ePTFE neochordae were used in six adult patients, four females and two males aged 23 to 79 years, with congenital heart malformations [46][47][48][49][50][51] (►Table 3). TR was due to dilatation of the tricuspid annulus in one, 46 absence of chordae tendineae to the anterior leaflet in one, 47 agenesis of the anterior papillary muscle in one, 50 and cleft of the anterior leaflet in one. 51 In one patient, TR was caused by iatrogenic chordal rupture during the percutaneous removal of a displaced atrial septal occluder 49 ; complex tricuspid roboticassisted reconstruction was achieved with multiple ePTFE neochordae.…”

Cellular and Molecular Mechanisms Underlying Tricuspid Valve Development and Disease

“…The leaflets may be thickened and elongated with variable degrees of associated regurgitation. Papillary muscles and cordae are also frequently abnormal, shortened, or even absent [27]. However, the absence of the "atrialized" RV guarantees preserved myocardial contractility, and the associated RV cardiomyopathy is rarer compared to EA.…”