Anterior leaflet-oriented tricuspid annuloplasty using a flexible ring for severe tricuspid regurgitation

We describe our concept and method of tricuspid annuloplasty using flexible ring for patients with severe tricuspid regurgitation accompanied by a severe tethering and a wide separation of the leaflets between the anterior leaflet and septal leaflet. The goal for our tricuspid ring annuloplasty using a flexible ring is to match the patient's own anterior leaflet configuration. We reduce the size of the tricuspid annulus respecting the individual configuration of the anterior leaflet to create a sufficient coaptation area of the leaflets. We performed this method in a 78-year-old female patient with very severe tricuspid regurgitation accompanied by a severe tethering. The anterior leaflet almost covered the orifice of the flexible ring during systole and intraoperative transesophageal echo examination revealed only trivial tricuspid regurgitation. We believe the anterior leaflet-oriented tricuspid ring annuloplasty using a flexible ring is useful for patients with severe TR accompanied by a severe tethering.