Tricuspid Valve Repair With Autologous Pericardium in PWID

The authors present a tricuspid valve repair utilizing autologous pericardium in a 29-year-old male with a history of drug injection (PWID). The intraoperative transesophageal echocardiogram (TEE) revealed a large mass attached to the anterior leaflet of the tricuspid valve, resulting in severe tricuspid regurgitation (TR). Following the establishment of cardiopulmonary bypass (CPB), a right atriotomy was performed to identify the vegetation. 

The procedure involves partial resection of the diseased anterior leaflet to facilitate proper examination of the subvalvular components. At times, resection of the posterior leaflet is also necessary to enable repair through bicuspidization of the new valve. Prior to fully resecting the leaflet, several Gore-Tex sutures are applied to the belly and tip of the papillary muscles. 

The repair begans with the placement of two 5/0 Prolene sutures at the annulus, anchored at the anterior/septal and anterior/posterior commissures. Additional Gore-Tex sutures were added based on the number of papillary muscles. The pericardium was then fashioned into a semicircular patch and sutured continuously to the annulus with 5/0 Prolene suture, extending between the previously placed anchors. 

New commissures were created by joining the neoleaflet with the native leaflet for several millimeters on both sides. After water testing, any redundant patch material was excised and shaped to form the free edge. Gore-Tex sutures were applied to the free margin, ensuring equal distribution to avoid pillowing. 

Further water testing and visual inspection were performed to adjust the leaflet height, with the approximate height marked by a metal clip for reference. Areas of commissural regurgitation were addressed with additional 5/0 Prolene sutures for final fine-tuning of the repair. The final water testing confirmed a satisfactory repair with good coaptation. Post-CPB TEE showed a successful repair with only trivial TR. 

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