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case_images: Preoperative transthoracic echocardiography demonstrating torrential tricuspid valve regurgitation. (A) Prolapse of the anterior tricuspid leaflet in apical four-chamber view (red arrow). (B) Quantitative assessment of tricuspid regurgitation using the proximal isovelocity surface area method. (C) The continuous wave Doppler signal of the regurgitant jet is truncated and triangular. Peak 1.7 m/s, effective regurgitant orifice area 0.98 cm2, and regurgitant volume 49 mL.
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case_images: Peak velocity of TR at continuous wave Doppler was 1.79 m/s (Figure 1A-D).
case_images: Intraoperative transesophageal echocardiography. Evidence of anterior leaflet tricuspid valve prolapse with rupture of primary chordae.
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case_images: Intraoperative transoesophageal echocardiogram (TOE) confirmed torrential TR with VC of 9 mm, EROA of 1.29 cm2, and a RVol of 62 mL (Figure 2).
case_images: Intraoperative tricuspid valve. Cleft of the anterior leaflet (outlined by dashes, left panel). View of the tricuspid valve after repair (right panel).
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case_images: Tricuspid Edwards annuloplasty ring was implanted with interrupted annuloplasty sutures (Figure 3).
case_images: Right coronary artery treatment. Coronary angiography demonstrating impingement of the mid right coronary artery by annuloplasty sutures (red arrow, left panel). Coronary angiography after coronary stent implantation (red arrow, right panel).
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case_images: Percutaneous coronary intervention with a 4.0 x 22 mm drug eluting stent was performed (Figure 4).
case_images: Pre-discharge transthoracic echocardiography with tricuspid valve repair. (A) Evidence of normal coaptation at the level of tricuspid valve annulus. (B) Trivial tricuspid valve regurgitation with mean pressure gradient 1 mmHg.
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case_images: The remaining postoperative course was uneventful and there was only a trivial TR with mean pressure gradient of 1 mmHg at discharge echocardiography (Figure 5A and B).