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J Chest Surg

Published online October 19, 2022

Copyright © Journal of Chest Surgery.

Chordae Tendineae Approximation Technique for Severe Tricuspid Regurgitation with Severe Leaflet Tethering Using a Totally Endoscopic Beating-Heart Strategy: A Case Report

Dong Hee Jang, M.D. , Jae Suk Yoo, M.D., Ph.D.

Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Correspondence to:Jae Suk Yoo
Tel 82-2-3010-1855
Fax 82-2-3010-6966
E-mail mdyoo77@gmail.com
ORCID
https://orcid.org/0000-0002-7008-054X

Received: July 28, 2022; Revised: September 13, 2022; Accepted: September 15, 2022

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Untreated severe tricuspid regurgitation (TR) is associated with poor outcomes. Functional TR occurs secondary to dilatation of the annulus and tethering of the leaflets. Ring annuloplasty alone can correct most cases, but is insufficient in cases of severe annular dilatation due to severe leaflet tethering. In such cases, a tricuspid edge-to-edge technique may be an option. However, stitching of the leaflet tips alone is likely to result in tearing of the leaflets. Approximation of the durable chordae tendineae is considered helpful for this problem. Herein, we present the case of a 39-year-old man who had undergone openheart surgery for acute type A aortic dissection 13 months earlier. A right mini-thoracotomy approach with a beating-heart strategy was used, which did not require unnecessary pericardial adhesiolysis and dissection. This technique had the advantage of reducing the operation time and the risk of bleeding. To summarize, we present a case of tricuspid valve repair in a high-risk patient with severe leaflet tethering that was successfully managed using these methods.

Keywords: Tricuspid valve insufficiency, Edge-to-edge repair, Minimally invasive cardiac surgery, On-pump beating cardiac surgery, Case report

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J Chest Surg

Published online October 19, 2022

Copyright © Journal of Chest Surgery.

Chordae Tendineae Approximation Technique for Severe Tricuspid Regurgitation with Severe Leaflet Tethering Using a Totally Endoscopic Beating-Heart Strategy: A Case Report

Dong Hee Jang, M.D. , Jae Suk Yoo, M.D., Ph.D.

Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Correspondence to:Jae Suk Yoo
Tel 82-2-3010-1855
Fax 82-2-3010-6966
E-mail mdyoo77@gmail.com
ORCID
https://orcid.org/0000-0002-7008-054X

Received: July 28, 2022; Revised: September 13, 2022; Accepted: September 15, 2022

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Untreated severe tricuspid regurgitation (TR) is associated with poor outcomes. Functional TR occurs secondary to dilatation of the annulus and tethering of the leaflets. Ring annuloplasty alone can correct most cases, but is insufficient in cases of severe annular dilatation due to severe leaflet tethering. In such cases, a tricuspid edge-to-edge technique may be an option. However, stitching of the leaflet tips alone is likely to result in tearing of the leaflets. Approximation of the durable chordae tendineae is considered helpful for this problem. Herein, we present the case of a 39-year-old man who had undergone openheart surgery for acute type A aortic dissection 13 months earlier. A right mini-thoracotomy approach with a beating-heart strategy was used, which did not require unnecessary pericardial adhesiolysis and dissection. This technique had the advantage of reducing the operation time and the risk of bleeding. To summarize, we present a case of tricuspid valve repair in a high-risk patient with severe leaflet tethering that was successfully managed using these methods.

Keywords: Tricuspid valve insufficiency, Edge-to-edge repair, Minimally invasive cardiac surgery, On-pump beating cardiac surgery, Case report

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