Tricuspid regurgitation secondary to mitral valve disease: when and how to repair.

The etiology of tricuspid regurgitation (TR) in North American patients with mitral valve disease is almost entirely nonrheumatic functional dilatation of the tricuspid annulus. In mild TR, no operative therapy is necessary since relief of the left sided valve lesion will suffice to bring the pulmonary pressure down and, consequently, relief of TR for moderate (2+ to 3+) TR. We have used a technique of posterior annuloplasty using a DeVega type double running braided suture beginning at the commissure of the anterior and posterior leaflets and running to the commissure between the septal and posterior leaflets, and tied over an obturator. The technique takes less than 10 minutes. Seventy-one patients in the past 10 years have been treated with this technique with virtually 100% relief of TR. For severe TR, we advocate the use of Carpentier-Edwards annuloplasty ring with interrupted sutures (16 patients). We believe severe TR requires a fixed annulus for virtually the entire circumference of the valve. Functionally regurgitant tricuspid valves should be reconstructed and not replaced. The use of repair techniques for moderate (posterior annuloplasty) or severe (Carpenter-Edwards tricuspid annuloplasty ring) TR will be satisfactory for virtually all patients with this lesion.