“…This is because it is difficult to predetermine the number of neochordae that will be necessary to achieve valve competence, and it is easy to rereconstruct new neochordae without injury to the hypoplastic papillary muscle when valve competence is not achieved after TV repair 5 . On the other hand, when the papillary muscle is hypoplastic, techniques where the proximal ends of the sutures pass through the free wall of the right ventricle, which is reinforced at both points with Teflon felt pledgets, are applicable for substitution of the papillary muscle 9,10 . Our patient, however, had a thinned right ventricle wall that affected RV loading; consequently, this method would have been unsuitable because of the potential for laceration of the right ventricle wall.…”