Kardiologie up2date 2011; 7(4): 250-256
DOI: 10.1055/s-0030-1257038
Hotline – Herzklappenerkrankungen

© Georg Thieme Verlag KG Stuttgart · New York

Chirurgische Therapie der funktionellen Trikuspidalklappeninsuffizienz

Utz  Kappert, Dominik  Joskowiak, Konstantin  Alexiou, Ahmed  Ouda, Steffen  Schön, Sems-Malte  Tugtekin, Klaus  Matschke
Further Information

Publication History

Publication Date:
09 February 2012 (online)

Abstract

Functional tricuspid regurgitation (TR) is a complex valvular lesion primarily arises from asymmetric dilatation of the tricuspid annulus in the setting of right ventricular dysfunction and enlargement in response to left-sided heart disease. The traditional view that functional TR generally resolves with surgical correction of the primary lesions is no longer hold. Concurrently, if untreated at the time of surgical mitral valve repair, significant residual TR negatively impacts perioperative outcomes, functional class and survival. Tricuspid ring annuplasty can be performed with minimal incremental morbidity and negligible mortality. Therefore, in addition to patients with severe regurgitation, annuplasty is now also recommended for patients with moderate TR or severe annular dilatation at the time of left-heart cardiac procedures. In combination with tricuspid ring annuplasty, the right ventricular reduction surgery as a novel adjunct procedure appears to be a promising strategy to avoid residual TR in this endangered patient population. In this article, we review the anatomy, pathophysiology, and value of surgical correction of TR, including the right ventricular reduction procedure.

Literatur

  • 1 Bonow R O, Carabello B A, Chatterjee K  American College of Cardiology/American Heart Association Task Force on Practice Guidelines , et al.. 2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease). Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons.  J Am Coll Cardiol. 2008;  52(13) e1-142
  • 2 Ghanta R K, Chen R, Narayanasamy N et al. Suture bicuspidization of the tricuspid valve versus ring annuloplasty for repair of functional tricuspid regurgitation: midterm results of 237 consecutive patients.  J ThoracCardiovasc Surg. 2007;  133(1) 117-126
  • 3 McCarthy P M, Bhudia S K, Rajeswaran J et al. Tricuspid valve repair: durability and risk factors for failure.  J ThoracCardiovasc Surg. 2004;  127(3) 674-685
  • 4 Filsoufi F, Salzberg S P, Coutu M, Adams D H. A three-dimensional ring annuloplasty for the treatment of tricuspid regurgitation.  Ann Thorac Surg. 2006;  81(6) 2273-2277
  • 5 Kay J H, Maselli-Campagna G, Tsuji K K. Surgical treatment of tricuspid insufficiency.  Ann Surg. 1965;  162 53-58
  • 6 De Vega N G. La anuloplastia selective, regulable permanente.  Rev Esp Cardiol. 1972;  25 555
  • 7 Carpentier A. Cardiac valve surgery – the „French correction“.  J Thorac Cardiovasc Surg. 1983;  86(3) 323-337
  • 8 De Bonis M, Lapenna E, La Canna G et al. A novel technique for correction of severe tricuspid valve regurgitation due to complex lesions.  Eur J Cardiothorac Surg. 2004;  25(5) 760-765
  • 9 Dreyfus G D, Raja S G, John Chan K M. Tricuspid leaflet augmentation to address severe tethering in functional tricuspid regurgitation.  Eur J Cardiothorac Surg. 2008;  34(4) 908-910
  • 10 Kappert U, Tugtekin S M, Ouda A et al. Right ventricular reduction as an adjunct procedure in tricuspid valve repair.  Ann Thorac Surg. 2008;  85(5) e27-29
  • 11 Shahzad G R, Dreyfus G D. Basis for intervention on functional tricuspid regurgitation.  Semin Thoracic Surg. 2010;  22 79-83

PD Dr. med. Utz Kappert

Herzzentrum Dresden GmbH Universitätsklinik
Klinik für Herzchirurgie

Fetscherstraße 76
01307 Dresden

Email: [email protected]