Tricuspid Valve Repair: How I Teach It

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Tricuspid Valve Repair: How I Teach It Nishant Saran, MD, Joseph A. Dearani, MD The Annals of Thoracic Surgery Volume 105, Issue 3, Pages 675-679 (March 2018) DOI: 10.1016/j.athoracsur.2017.08.063 Copyright © 2018 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Tricuspid annular dilatation. Maximum dilation occurs along the inferior annulus followed by the anterior annulus. (A = anterior; I = inferior; S = septal.) (Used with permission of Mayo Foundation for Medical Education and Research. All rights reserved.) The Annals of Thoracic Surgery 2018 105, 675-679DOI: (10.1016/j.athoracsur.2017.08.063) Copyright © 2018 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 (A) Ring annuloplasty with pledgeted stitches at anteroseptal and coronary sinus region. (B–D) Suture repair of leaflet, exteriorization of pacing lead, and ring annuloplasty. (Used with permission of Mayo Foundation for Medical Education and Research. All rights reserved.) The Annals of Thoracic Surgery 2018 105, 675-679DOI: (10.1016/j.athoracsur.2017.08.063) Copyright © 2018 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Artificial chords to anterior leaflet with pledgets anchored in heavy trabeculations toward the right ventricular apex (arrow). (Left) Coronal section of the heart. (Right) Surgeon's view through right atriotomy. (LV = left ventricle; m. = muscle; RV = right ventricle.) (Used with permission of Mayo Foundation for Medical Education and Research. All rights reserved.) The Annals of Thoracic Surgery 2018 105, 675-679DOI: (10.1016/j.athoracsur.2017.08.063) Copyright © 2018 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Artificial chords to septal leaflet, with pledgets toward the right ventricle apex on septal side. (Left) Coronal section of the heart. (Right) Surgeon's view through right atriotomy. (A = anterior; I = inferior; S = septal.) (Used with permission of Mayo Foundation for Medical Education and Research. All rights reserved.) The Annals of Thoracic Surgery 2018 105, 675-679DOI: (10.1016/j.athoracsur.2017.08.063) Copyright © 2018 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 (A) Autologous pericardial patch augmentation of the anterior leaflet to increase leaflet height and improve coaptation. (B) Artificial chordae to the anterior leaflet are also shown (arrow). (LV = left ventricle; m. = muscle; RV = right ventricle.) (Used with permission of Mayo Foundation for Medical Education and Research. All rights reserved.) The Annals of Thoracic Surgery 2018 105, 675-679DOI: (10.1016/j.athoracsur.2017.08.063) Copyright © 2018 The Society of Thoracic Surgeons Terms and Conditions