An unusual case of congenital Tricuspid Valve Anomaly

Abstract

Background. A 38 years old man is presented with acute onset with dyspnoea for 2 months. From anamnesis is known that he suffered 10 years ago a car accident complicated with multiple fracture. Patients is unknown with cardiac pathology and he does not use any medication.Case report. Upon arrival at the emergency department, his vital signs were: blood pressure 120/80 mmHg, heart beat 70 beats/min, body temperature 36.7 C and O2 saturation 98 %. Electrocardiography (ECG) registered right bundle branch block. Initial laboratory data didn’t revealed any abnormalities. Transthoracic ECHO CG, which was performed when the patient arrived at the hospital, showed normal ejection fraction (EF- 57 %), severe dilated right heart chambers and severe tricuspid regurgitation with suspicion of rupture of septal leaflet. As well, heart MRI was made to establish cardiac diagnosis. Heart MRI registered: Dysplasia of the septal cusp of the tricuspid valve. Severe tricuspid valve regurgitation (regurgitation volume – 110 ml, regurgitation fraction – 55%). Right ventricle is severely dilated, global systolic function normally. Right atrium severe dilated. Was made differential diagnosis between posttraumatic rupture of tricuspid valve and congenital tricuspid valve anomaly. The patient was consulted by cardio-surgeons and was disseated heart intervention for the Tricuspid Valve repair. During the intervention was noticed severe dilated ring of Tricuspid Valve (65 mm). Posterior leaflet with rupture of chordae, septal leaflet pasted by sept with abnormal attached of chordae. The anterior leaflet with abnormal big dimension and total prolapse in the right atrium. Foramen ovale patent. A tricuspid valve anomaly was confirmed. There was made Tricuspid Valves repair with implantation of the ring. Due to severe dilatation of the ring of Tricuspid Valve it wasn’t possible to apply a classic method of Tricuspid Valve repair. Two techniques were combined to solve our patient’s problem. The annuloplasty was made by Kay technique, the posterior leaflet was completely excluded, and a functional bicuspid valve is finally obtained. After that was stitched together the middle point of the free edges of the tricuspid leaflets by Alfieri technique. In cases of severe annular dilatation, annuloplasty alone is unlikely to be durable so an additional procedure, such as “clover technique,” was used to obtain a more durable repair. On ECHO made in dynamics was revealed Tricuspid Regurgitation of second degree with persisting severe dilatation of right chambers. The dyspnoea after surgery improved and the patient was discharged after 5 days post - surgery. Conclusions. Tricuspid valve disease affects millions of patients worldwide. It has always been considered less relevant than the left-side valves of the heart, but still represents a great challenge for the cardiac surgeons, especially in the most difficult symptomatic scenarios. When possible, valve repair still remains the most useful procedure, while replacement is generally preferred in the most demanding cases. Only the accurate choice of the most appropriate procedure will provide optimal and long-term results.