Bicuspidization of the tricuspid valve: A repair option for severe acute endocarditis

Introduction: Tricuspid valve endocarditis is challenging because in most cases there are multiple leasons requiring complex repair and the anterior leaflet is often involved. Frequently, treatment has been valve replacement, associated with the well-known morbidity of valve prostheses in tricuspid position. Some techniques for repair of infected tricuspid valves have been reported aiming at preservation of the valve by using autologous or foreign pericardium with varying results due to shrinking.

Aims: We report of a 60-year-old male with tricuspid valve endocarditis caused by streptococci. TEE showed severe tricuspid valve regurgitation with prolapse of the anterior leaflet due to ruptured chordae with vegetations on the anterior leaflet. Repair was performed by transfer of the posterior leaflet tissue and chordae not only to repair the prolapse but also to cover the perforation. Subsequently the annulus of the posterior leaflet was excluded in the resected area and an Edwards® classic anuloplasty ring (30 mm) was implanted. No pericardium was used. P.o. TEE and TTE at discharge showed no tricuspid regurgitation. Follow-up at 12 months with TTE showed no re-infection and complete tricuspid valve competence.

Discussion: The high morbidity of tricuspid valve replacement justifies any attempt for repair the valve in endocarditis. Even extended destruction of the tricuspid valve including the leaflets can be repaired by utilisation of the posterior leaflet as chordal transfer to treat a prolapse and as patch to close a perforation of the anterior leaflet. This technique shows excellent postoperative and mid-term results without the risk of shrinking or calicfication.