REPAIR OF CONGENITAL TRICUSPID-VALVE ABNORMALITIES WITH ARTIFICIAL CHORDAE TENDINEAE

Background. Congenital abnormalities of the tricuspid valve, including Ebstein's malformation, dysplasia, straddling,;md those found in pulm onary atresia with intact, septum and congenitally corrected transposi tion, are an uncommon cause of tricuspid regurgitation. Congenital tri cuspid valve anomalies are found as a spectrum of disease in which bot h the leaflets and the subvalvar apparatus are often involved. Tricusp id valve repair is complicated in such patients because the chordae te ndineae are often abnormally short and thick. Replacement or augmentat ion of chordae tendineae has proved to be a useful component of mitral valve repair. In the present report, we describe the techniques and r esults of chordal augmentation in the repair of congenital tricuspid v alve abnormalities. Methods. Since July 1992, tricuspid valve repair h as been performed in 5 children with severe tricuspid regurgitation se condary to congenital abnormalities of the tricuspid valve with signif icant chordal pathology. As a component of the repair, chordal replace ment or augmentation was performed using expanded polytetrafluoroethyl ene suture. Results. Intraoperative and postoperative echocardiographi c assessment showed good mobility of the tricuspid valve leaflets and trivial to mild tricuspid regurgitation. There were no complications a nd no early or late mortality. At follow-up of 34 to 60 months (median , 49 months), tricuspid valve function has remained excellent in 4 of the 5 patients. In the remaining patient, progressive regurgitation of the right ventricle to pulmonary artery allograft conduit has led to right ventricular dilatation, with a secondary increase in tricuspid r egurgitation from trivial to moderate, Conclusions. Chordal replacemen t or augmentation with expanded polytetrafluoroethylene suture is a us eful technique in the repair of congenitally dysplastic tricuspid valv es with abnormal chordal structures. (Ann Thorac Surg 1998;66:172-6) ( C) 1998 by The Society of Thoracic Surgeons.