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Correspondence

Reply

Division of Cardiovascular Surgery, Yonsei Cardiovascular Center, Yonsei University Health System, 250 Seongsanno, Seodaemun-gu, Seoul 120-752, South Korea

(Email: bcchang{at}yuhs.ac).

To the Editor:

We thank Drs Al-Ebrahim and Al Alassal [1] for their interest in our article on tricuspid annuloplasty for functional tricuspid regurgitation using an autologous pericardial strip [2]. He reports three cases of tricuspid annuloplasty with modifications such as: (1) performing the annuloplasty on the beating heart after release of the aorta cross clamp, (2) preparation of the pericardial strip using an appropriate tricuspid obturator sizer, and (3) crossing the anteroseptal and posteroseptal commissures.

First, we believe that annuloplasty with a beating heart after release of aorta cross clamp reduces myocardial ischemic time. However, exposure with a beating heart is not as good as that of an arrested heart, and thus more time may be needed. We usually release the aortic cross clamp just after tying the sutures.

Second, the estimated length of pericardial strip that we use is approximately ²/₃ to ³/₄ x 2R (R = radius of tricuspid valve) as described in the article. This is a very simple calculation and does not require any devices. However, we agree that the obturator sizer, as recommended by Drs Al-Ebrahim and Al Alassal [1] may be helpful in children.

Third, having the annuloplasty suture cross the posteroseptal commissure is very important, as we described. However, we doubt the value of the annuloplasty at the anteroseptal commissure. As we all know, there are two important nearby structures. The aortic sinus is located adjacent to the anteroseptal commissural area and the annuloplasty sutures may reduce the anteroseptal commissural annulus. The other nearby anatomic structures are the membranous septum and conduction tissue. Thus, it is not easy or necessary to reduce the anteroseptal commissural annulus in functional tricuspid regurgitation. Instead, we used one to two figures of eight sutures at the anteroseptal commissure in several cases, when there is some fibrosis and a gap at the area.

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1. Al-Ebrahim K, Al Alassal A. Autologous pericardial strip repair of the tricuspid valve (letter) Ann Thorac Surg 2010;89:674.[Free Full Text]
2. Chang BC, Song SW, Lee S, Yoo KJ, Kang MS, Chung N. Eight-year outcomes of tricuspid annuloplasty using autologous pericardial strip for functional tricuspid regurgitation Ann Thorac Surg 2008;86:1485-1493.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Byung-Chul Chang Sak Lee Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Chang, B.-C. Articles by Seol, S.-Y. Search for Related Content PubMed PubMed Citation Articles by Chang, B.-C. Articles by Seol, S.-Y. Related Collections Related Article