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Abstract
Tricuspid valve (TV) consists of three leaflets, anterior leaflet is quadrangular and is the largest one, its chordae are derived from anterior and posterior papillary muscles. The posterior leaflet is the smallest and is triangular , its chordae are also derived from anterior and posterior papillary muscles, the septal leaflet is semicircular, the atrioventricular node lies in close proximity to the septal leaflet at the apex of triangle of Koch. Tricuspid valve insufficiency is most often functional secondary to left sided cardiac pathology with subsequent pulmonary hypertension, right ventricular and annular dilation. Otherwise it may be organic due to infectious endocarditis carcinoid heart disease and Ebstein anomaly. Functional TR may diminish or disappear after following the treatment of Left-sided lesions, however it may persist. the prediction of this is difficult . Pulmonary hypertension, increased right ventricular pressure and dimension, reduced right ventricular fuction, and the diameter of tricuspid annulus are important risk factors of persistence or late worsening of TR. As general principle conservative surgery is preferable to valve replacement and surgery should be carried early enough to avoid irreversible right ventricular dysfunction. severe TR should be corrected at the time of left-sided valve surgery, moderate TR should be corrected when there is pulmonary hypertension or severe dilatation of the annulus (diameter ›40mm or ›21mm/m2 )and even more so, if TR is of organic origin. mild TR does not warrant intervention. The De Vega annuloplasty technique for repair of TR (Tricuspid regurgitation) has the advantage of a relative absence of foreign material compared with ring annuloplasty avoids the cost of a ring and is performed quickly. The further refinement using TEE ( Transesophageal echo) guides the tightness to avoid stenosis. In 1972 De Vega described an adjustable annuloplasty technique, consists of placement of a double purse string suture in the tricuspid annulus encompassing the bases of the anterior and posterior leaflets which is then tightened sufficiently to reduce the annular circumference and eliminate regurgitation. To adjust the degree of constriction of the annulus in the beating heart, after discontinuation of cardiopulmonary bypass, the original method was modified in 1974 by Alonso-lej and Cofino, they described leading the ends of the purse string suture through the atrial wall, this allows adjustment of the tension on the purse string suture external to the heart after the patient is weaned from bypass . The use of intraoperative echo in TV(Tricuspid valve) and other cardiac valve surgery prevented a significant number of patients from leaving the operating room with either undiscovered or inadequately corrected valve dysfunction that could have translated to an increased postoperative morbidity and mortality .