ISSN : 1301-5680
e-ISSN : 2149-8156
TURKISH JOURNAL OF
THORACIC AND
CARDIOVASCULAR SURGERY
Turkish Journal of Thoracic and Cardiovascular Surgery     
SEVERE FUNCTIONAL TRICUSPID REGURGITATION: “MODIFIED SEMICIRCULAR CONSTRICTIVE ANNULOPLASTY” TECHNIQUE AND MIDTERM RESULTS
İbrahim GÖKŞİN, Gökhan ÖNEM, Ahmet BALTALARLI, Mansur ŞAĞBAN, *Arif YILMAZ, *Hakan KARA, **Ufuk Ali TÜRK, ***Nagihan KARAHAN
Pamukkale Üniversitesi Tıp Fakültesi, Kalp Damar Cerrahisi Ana Bilim Dalı, Denizli
*İzmir Atatürk Eğitim ve Araştırma Hastanesi, Göğüs Kalp Damar Cerrahisi Kliniği, İzmir
**İzmir Atatürk Eğitim ve Araştırma Hastanesi, Kardiyoloji Kliniği, İzmir
***İzmir Atatürk Eğitim ve Araştırma Hastanesi, Kardiyak Anestezi ve Reanimasyon Kliniği, İzmir
Background: The aim of this new annuloplasty was to prevent the occurence of recurrent tricuspid regurgitation secondary to Bowstring (Guitar string) phenomenon as a result of gliding (jiggle) effect seen in De Vega annuloplasty, and to provide symmetrical annular reduction and constriction and also to protect the physiological movements of the annulus.

Methods: Twentyfive patients, who had severe functional tricuspid regurgitation and operated for left sided rheumatic valvular disease, were included into this study. 0 No and 2/0 No polypropylene suture materials were used for this annuloplasty. Every one of both sutures were fixed and knotted at anteroseptal and posteroseptal comissural regions in both ends of free wall annulus. 2/0 polypropylene sutures coming from the anchoring points were used to wrap the free wall annulus itself totally as well as the 0 No polypropylene sutures in spiral fashion. For proper correction of regurgitation 0 No polypropylene sutures were used for reduction and constriction, 2/0 No polypropylene sutures were used for the fixation of 0 No polypropylene sutures in annular level.

Results: Functional tricuspid regurgitation had improved totally in 16 patients (66.7%); 4 patients (16.7%) had 1°, 3 patients (12.5%) had 2° and only one patient (4.2%) had 3° residual tricuspid regurgitation in mid-term period. 2 patients (8.4%) had evolved transvalvular gradient (2.55 mmHg and 2.8 mmHg). One patient died from low cardiac output in early post operative period. Mean follow up period was 17.8 months (range between 1 and 32 months).

Conclusion: This new annuloplasty can be performed easily. Moreover, this technique is reproducible and also cost effective.

Keywords : Tricuspid, regurgitation, annuloplasty, De Vega annuloplasty, Bow string phenomenon
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