How to Perform an Aortic Annulus Enlargement With Tricuspid Repair

This video describes a 73-year-old woman with severe aortic and tricuspid regurgitation due to rheumatic fever. The inferior vena cava (IVC) cannula was placed in the right femoral vein, and direct aortic cannulation along with antegrade cardioplegia were performed.  First, the aorta was opened, and the aortic valve leaflets were resected.  The annulus was sized, and it was determined that it would not accommodate a 23 mm valve; thus, an enlargement procedure was performed by extending the aortic incision down between the left and non-coronary cusps.  A flame-shaped Dacron patch was inserted and sutured into this incision to enlarge the annulus. A 23 mm Mosaic valve was then easily placed using horizontal mattress sutures.  The patch was then contoured to facilitate closing the aorta. The left atrial appendage was also removed with a stapler. Subsequently, the right atrium was opened, and a 3D contoured tricuspid annuloplasty ring was used to repair the severely dilated tricuspid valve.  

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