CHIRURGIE CARDIAQUE/CARDIAC SURGERY MODIFIED DE VEGA ANNULOPLASTY FOR FUNCTIONAL TRICUSPID VALVE REGURGITATION

Objectives: Tricuspid valve regurgitation is mostly functional and secondary to mitral valve and or without aortic valve diseases. Modified De Vega annuloplasty is one of the effective methods used in the surgical correction of functional tricuspid valve regurgitation. This study evaluates the long term results of modified De Vega annuloplasty for functional tricuspid valve regurgitation at the National Cardiothoracic Centre. Patients and Methods: From March 1993 to July 2005, 64 consecutive patients who had modified De Vega annuloplasty for tricuspid valve regurgitation (TVR) were retrospectively selected for the study. The preoperative echocardiographic records of all patients with TVR were retrieved. The age, sex and the specific heart diseases were recorded. All the patients had follow up echocardiography at least once every two years and the tricuspid valve function reported from the latest postoperative echocardiographic reports were recorded. Results: The average follow-up period after tricuspid valve repair was 61.3 months (5-133 months). Six (9.4%) had grade II post-operative tricuspid valve regurgitation and 17 (26.5%) had grade I post-operative tricuspid valve regurgitation. No post-operative regurgitation was seen in 41 (64.1%) of those who had modified De Vega annuloplasty. Mitral valve incom petence mostly secondary to rheumatic heart disease accounted for 81.3% (n= 52) of the causes of functional tricuspid valve regurgitation. Combined mitral and aortic valve regurgitation accounted for 9.4% (n = 6), mitral valve stenosis 7.8% (n = 5) and one (1.6%) case of functional tricuspid valve incompetence was associated with atrial septal defect. There was no post-operative heart block and no suture tear was observed in the 64 cases that had the modified De Vega annuloplasty. There were three deaths during the period of review. One died 9 years after surgery from arrhythmia and two died from post-operative dilated cardiomyopathy in their second year after the surgery. Conclusion :Modified De Vega annuloplasty for tricuspid valve regurgitation is an effective, safe and a simple procedure to perform. In a developing country like Ghana, where most of our patients are poor and can not easily afford ring annuloplasty, De Vega annuloplasty remains the procedure of choice in the management of functional tricuspid valve incompetence.