1993;9( ! ):035-038 ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: TECHNICAL OPTIONS Tricuspid Annuloplasty: A Modified Technique B. K. Gupta, M. Akhter, Rakesh Gupta, Suvira Gupta, M. Nigam, S. K. Khanna, D. K. Satsangi, D. K. Tempe, A. S. Tomar Fifty patients with rheumatic multivalvular disease underwent a modified form of semicircu- lar tricuspid annuloplasty for acquired tricuspid insufficiency along with mitral or mitral and aor- tic valve procedures. The modification allowed simu/ataneous tying of annu/op/asty sutures and digital assessment of the tricuspid reguro~itation on unsupported normotherm/c beating heart. Early postoperative assessment showed 8 (17.3%) patients with no regurgitation, 36 (78.2%) with trivial to mild regur~qitation and 2 (4.3%) with moderate regurgitation. There were 4 (8%) early deaths not related to the tricuspid lesion. Over a follow-up period of 6-84 (mean 38) months with around 70 per cent compli- ance, only three patients showed progression of tricuspid regurgitation. In all other patients the tricuspid regurgitation remained controlled. The study suggests that the modified annuloplasty technique used is an efficient way to achieve predictable annuloplasty results. From the Departments of Cardiothoraclc Surgery, Radiology and Anaestheslology, G.B. Pant Hospital, New Delhi, India. Address for correspondence: Dr. B.K. Gupta Professor of Cardiothoracic Surgery, G.B. Pant Hospital, New Delhi-110 002, INDIA. Control of acquired tricuspid regurgitation along with mitral and aortic surgery has been shown to affect the immediate and early postop- erative periods in a favourable way. 1-4 Suture or ring annuloplasty has become the most accepted technique for dealing with significant acquired tricuspid insufficiency. The usual way of perform- ing a semicircular tricuspid annuloplasty entails tying of annuloplasty sutures with two fingers 4 or around a sizer s in the tricuspid orifice. Others use figure of eight 6 or pledgetted mattress sutures 7 to reduce the annular dilatation, achieving compe- tence. Reduction in annulus can also be achieved by plication of anterior annulus and resuspension of anterior leaflet. 8 Ring annul0Plasty using vari- ous rings 9.t~ reduces the circumference of the annulus and at the same time remodels and sup- ports it. All these procedures are, however, done in a cardioplegic heart and attempt to reduce the tricuspid insufficiency by reducing the annulus to a pre-fixed diameter. We report a modified form of semicircular tricuspid annuloplasty deployed in 50 cases. This procedure allows simultaneous tying of sutures and digital assessment of the disappearing tricus- pid regurgitation without compromising the right atrial cavity, Thus a predictable result is assured. TECHNIQUE On routine cardiopulmonary bypass we first deal with the mitral and, where necessary, aortic 35