Papillary Muscle Cross-Control Technique to Overcome Excessive Leaflet Tethering in Complex Tricuspid Valve Repair
Longstanding tricuspid valve regurgitation (TR), either of functional or organic origin, might lead to severe right ventricular (RV) dilatation and/or dysfunction. The chordal shortening caused by papillary muscle displacement secondary to marked RV dilatation results in severe leaflet tethering and progressive lack of coaptation, which makes the tricuspid valve repair surgery much more complicated. The annular and RV wall dilatation occurs mostly in the anteroposterior commissure parts and the septal area is less involved. The tricuspid valve tethering distance, which is measured as the distance between the annular plane and the coaptation point, has been proven as the primary independent parameter predicting residual TR (1).
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