Tricuspid valve repair using the proportion between segments of normal tricuspid annulus as a parameter for annuloplasty.

OBJECTIVE To determine the proportion between the segments of the normal human tricuspid valve (TV) annulus and its use as a parameter for ring annuloplasty "in vitro" and "in vivo". METHODS Digital images of the tricuspid ring of 30 human cadaveric hearts, without fixation and without tricuspid regurgitation (TR), were analyzed and the proportion between the antero-posterior and septal segments was determined. This proportion was used for TV annuloplasty with bovine pericardium (BP) flexible rings on 15 hearts from adult cadavers with TR and ring dilatation. The same proportion and technique were used for TV repair on 11 patients with functional TR. Preoperatively, seven patients had severe and four moderate TR; five patients were class IV and six class III (NYHA). RESULTS The mean ratio between the antero-posterior and septal segments was 2.43+/-0.212 in the 30 hearts without TR. The mean size of the BP flexible ring used for "in vitro" surgical procedure was 71.5+/-5.2 mm, median 70 mm, and there was no TR after that in all 15 hearts. The mean size of the orthesis used on the patients was 73.4+/-6.5 mm, median 72 mm. There was 1 hospital death. Six months after surgery, 7 patients had no TR and 3 had mild TR; 6 patients were in NYHA class I, 3 in class II and 1 in class III. CONCLUSION The use of the ratio 2.43:1 between the anterior-posterior and septal segments as a parameter in tricuspid valve annuloplasty with a bovine pericardium flexible ring leads to satisfactory results.