人工弁輪を用いた後尖弁輪縫縮による三尖弁輪形成術

Tricuspid Valve Ring Annuloplasty with Posterior Annular Plication for Functional Tricuspid Regurgitation

機能性三尖弁閉鎖不全症（TR）に対して三尖弁後尖弁輪を縫縮するように人工弁輪を縫着する三尖弁輪形成術（TAP）を施行し，最長11年6ヵ月の経過観察をしえたので報告する．

This report presents a modified procedure of tricuspid valve ring annuloplasty （R-TAP） with posterior annular plication for functional tricuspid regurgitation （TR）. Sutures on the native annulus were placed by a standard fashion in R-TAP, and those on the posterior annulus and its bilateral commissures were passed through in a narrow range between the 3 and 4 o’clock positions of the 26-mm ring. The other sutures were done with an usual manner and the ring was fixed to the annulus, resulting in the posterior annular plication （bicuspidization）. Follow-up was performed for more than 5 years （mean：7.9 years, range：5.5～11.5 years） by echocardiography in 13 cases. Postoperative TR reduced significantly to less than moderate, which was maintained during the entire follow-up period, even in the case with atrial fibrillation. There was no sign of tricuspid stenosis. R-TAP with posterior annular plication was feasible, reproducible, and effective, although further investigation is needed.