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An Overview of Tricuspid Valve Repair

written by: Vasanth • edited by: Diana Cooper • updated: 4/10/2011

The tricuspid valve directs blood flow in the heart from the atrium to the ventricle. It can become diseased or damaged with age. Tricuspid valve repair involves supporting the valve leaflets with an annuloplasty ring so that they open & close properly. The latest surgical techniques use robotics.

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    What is the Tricuspid Valve?

    The tricuspid valve is one of four valves in the heart. It opens and closes with each heart beat, allowing blood to flow through the chambers of the heart. The tricuspid valve directs the blood from the right atrium to the right ventricle. It lies between these two chambers. The atrium is the upper chamber of the heart, and the ventricle is the lower chamber.

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    Tricuspid Valve Disease

    The tricuspid valve can become diseased with age. One type of disease which affects the valve is regurgitation, where the valve doesn't close tight and is leaky. Since the valve doesn't block the opening between the right atrium and right ventricle properly, a small amount of blood flows backwards.

    Another disease which affects the tricuspid valve is stenosis. This is characterized by stiff valve leaflets that don't open wide enough. It hinders the forward flow of blood from the atrium to the ventricle.

    Valve disease is caused by several things. Rheumatic fever and infective endocarditis are two infections that could damage the tricuspid valve. High blood pressure is another cause of tricuspid valve disease. Less likely causes include congenital defects and trauma.

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    Tricuspid Valve Repair

    There are several options to repair the tricuspid valve. A commissurotomy involves widening the valve opening by separating fused valve leaflets. Decalcification involves removing calcium deposits on the valve leaflets, which results in a more flexible valve that closes more tightly. Annulus support, or annuloplasty, involves reshaping or tightening a wide valve annulus by stitching a ring around the annulus. The ring is made of tissue or a synthetic material. Patching leaflets is a tricuspid valve repair that involves filling holes or tears in the leaflet with tissue.

    Tricuspid valve repair surgery was traditionally done through open-chest procedures, where the breastbone is cut and the ribs are separated. The surgeon would stop the heart and place the patient on a heart-lung machine to circulate blood while the valve is repaired.

    A minimally invasive procedure is currently in use which uses a smaller incision and allows the surgeon to work on the beating heart. There is also a robotically assisted minimally invasive procedure which is even less stressful to the patient. This technique uses endoscopic instruments, controlled by a robotic surgical system, to reach the heart through a two inch incision. The system uses a 3-D camera to guide the instruments. The surgeon controls the movements and placement of the instruments.

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    Benefits of Robotically Assisted Valve Surgery

    There are several benefits to robotically assisted valve surgery. The hospital stay is much shorter than the traditional surgery. The patient experiences less trauma and less pain. Since the incision is so small, scarring is kept to a minimum. There is less bleeding, and the risk of infection is less.

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    Reference

    1. "Tricuspid Valve Disease." Cleveland Clinic. http://my.clevelandclinic.org/heart/disorders/valve/tricuspid.aspx

    2. "Valve Surgery." Cleveland Clinic. http://my.clevelandclinic.org/heart/disorders/valve/valvetreatment.aspx

    3. "Tricuspid Valve Repair." Cleveland Clinic. http://my.clevelandclinic.org/heart/services/surgery/roboticallyassistedtricuspid.aspx