ADJUSTED DE VEGA TRICUSPID ANNULOPLASTY GUIDED BY INTRAOPERATIVE TRANSESOPHAGEAL ECHOCARDIOGRAM

Abstract

Functional tricuspid regurge (FTR) is an important dilemma in cardiac surgery, and tricuspid annular dilation is a reliable indicator of the degree of FTR. Many methods are available for repair: Ring repair is believed to be more durable than suture annuloplasty, however the suture repair still holds a place. This work was conducted over 60 patients with history of rheumatic heart disease with predominance mitral valve diseases, pulmonary hypertension (PH) and FTR.Group I : 30 patients had ADVTA using intraoperative TEE. Group II: 30 patients had conventional De Vega tricuspid annuloplasty(CDVTA). The two groups were assessed immediately and six months later by TTE. There was a significant relation between PH and tricuspid valve annulus diameter (TVAD) in Group I (mean TVAD in PH grade 2 is 38.0+6.5 mm, while in PH grade 3 mean TVAD is 41.1+4.6). Also PH correlates significantly with TVAD in Group II. Results showed advantage of ADVTA in avoiding postoperative residual TR due to accurate application of tension(Preoperative FTR grade 2 in 12 patients and FTR grade 3 in 18 patients, immediate postoperative TR grade 2 in 4 patients and no patient in TRgrade 3,late postoperative TR grade 2 in 6 patients and TR grade 3 in one patient). Results demonstrated superiority of ADVTA in decreasing postoperative diastolic gradient(PODG) on tricuspid valve and in avoiding tricuspid stenosis (immediate PODG in Group I is 5.4+3.2 mmHg and 9.1+3.3mmHg in Group II, late PODG in Group I is 5.9+3.3 mmHg and 9.9+3.5 mmHg in Group II). ADVTA guided by TEE still holds a place as it is quick, inexpensive, devoid of use of foreign body especially in the presence of infection, and showed durability.