Surgically created double orifice repair of tricuspid regurgitation in infants with congenital heart disease

Repair of tricuspid regurgitation (TR) in infants with congenital heart disease (CHD) is frequently associated with postoperative morbidity. Annuloplasty is a well-established surgical procedure for TR and is associated with a satisfactory postoperative outcome provided the deformity of the tricuspid leaflet is mild. However, in the presence of severe leaflet deformity, the reparative procedure remains a surgical challenge. The present study describes our experience with the surgically created double orifice repair of the tricuspid valve in infants with CHD and significant TR. Clinical Summary PATIENT 1. A 7-month-old male infant was referred to our hospital at 1 month of age with the diagnosis of double outlet from the right ventricle, pulmonary hypertension, TR, and bronchial stenosis. At 2 months of age, the clinical condition deteriorated progressively due to respiratory tract infection. Although he underwent pulmonary artery banding (PAB) at 3 months of age, weaning from the respirator was unsuccessful. At 7 months of age, he underwent a definitive operation, in which intraventricular rerouting was established with a 0.4-mm Gore-Tex patch (W. L. Gore & Associates, Inc, Flagstaff, Ariz) connecting the left ventricle with the aorta. The tricuspid valve was dilated to 23 mm and showed a diffuse degenerative change with deficient valvar tissue near the commissure between the anterior and septal leaflet (Figure 1, B). Because Reed’s annuloplasty at this area failed to alleviate TR, a double orifice repair was performed wherein the central free edge of the anterior leaflet was approximated to the facing edge of the septal leaflet with a 5-0 polypropylene mattress suture (Figure 1, C). The divided orifices were equal in size, each measuring 10 mm. The patient recovered uneventfully and was weaned from the respirator on postoperative day 5. The mean right atrial pressure ranged from 5 to 9 mm Hg in early postoperative days and was 3 mm Hg at 6 months after surgery. Postoperative Doppler echocardiography demonstrated a divided unobstructed flow through the tricuspid