ACRT Journal

1.       Objective

We created a new suture technique for tricuspid valve replacement, that provides less amount of PVL outcome. The suture technique, we named ‘Nebigil technique’ can be described as a ‘one by one, interlocked   suture technique’ and each suture has to be supported by teflonpledget.

Tricuspid valve replacement is known as one of the most complicated replacement, including cardiac valves replacements.

In order to prevent possible leakage incidence, this technique can be used safely.

2.       Methods

A 17 years old male patient referred to the hospital (S.S.K. Ankara Training and Research Hospital) with symptoms such as dyspne, cyanosis, cardiomegaly and congestive heart failure.  After physical and laboratory examinations, followed by echocardiography, angiography revealed Ebstein’s anomaly, combined with Patent Foramen Ovale (PFO).

The patient had operation in 1997; cardiopulmonary bypass with 28^ºC hypothermia, bicaval cannulation and   cold cardioplegia was applied. PFO was closed primarily, tricuspid valve was excised totally, and right atrium was enlarged with a PTEF patch.

The broken suture would take more space than our new technique (x1>x2).

Therefore, paravalvular leakage morbidity would be higher in other technique than that of our new technique.

3.       Results

Seven days after the operation, the patient was discharged without any complication. Digoxin, diuretic, warfarin and aspirin were prescribed. In 6- months- interval, the patient was followed up for 2 years. Also, he was controlled every year by echocardiography. After the operation, apparent recovery was seen immediately. His effort capacity improved from NYHA III to NYHA I. He has been doing well, according to the recent check up.

4.       Conclusion

This technique can provide less amount of PVL outcome.

Figure 1: Each of sutures is interlocked one another.

Figure 2: Each of sutures is interlocked one another.

Figure 3: Each of loops is knotted by itself.

Figure 4: Each of sutures is interlocked one another; (a=b=c, Leakage area: x1>x2, Three sutures distance: y2>y1, Broken suture: b).

Figure 5: Each of loops is knotted by itself (a=b=c, Leakage area: x1>x2, Three sutures distance: y2>y1, Broken suture: b).