Tricuspid Annuloplasty: Comparative Study Of

Tricuspid repair is indicated in patients with significant functional tricuspid regurgitation. Color-Doppler now mapping is a non-invasive, accurate, extremely sensitive and specific method for assessing presence, severity and etiology of tricuspid regurge. It plays a major role in decision making, patient selection, and planning tricuspid repair. Also, it is useful postoperatively in evaluating the adequacy of TV repair. The septal leaflet of the tricuspid valve requires less attention during tricuspid repair.Semicircular tricuspid annuloplasty is the treatment of choice for acquired functional tricuspid insufficiency as it preserves the physiologic annular motion and the natural undulation in the opening and closing mechanism of the tricuspid valve.De Vega semicircular tricuspid annuloplasty has the advantage of being a rapid and simple procedure, reduces the amount of intracardiac prosthetic material, maintains annular flexibility and reduces the potential for conduction system injury, so adding no operative risk and the ability to be done on a beating heart. But it requires careful balancing of persistent residual tricuspid regurgitation against the potential production of tricuspid stenosis. De Vega tricuspid annuloplasty offers good early functional results with substantial reduction in hospital mortality and morbidity. However, its long term results are unsatisfactory with tearing of the suture from the myocardium and residual TR occurs.After suture tricuspid annuloplasty using the De Vega or Kay method, the tricuspid annulus can contract flexibly with the RV pumping action, but elevation of RV pressure can enhance complications including suture material detachment and escape. In contrast, ring annuloplasty with Carpentier-Edwards ring may be associated with loss of tricuspid annular contraction involved in RV function, however, it can prevent redilatation and recurrence of TR. Therefore, questions have arisen regarding the most physiologic and biocompatible method for tricuspid annuloplasty.