Abstract:

Objective To explore the value of intraoperative transesophageal echocardiography (TEE) in minimally invasive reoperative tricuspidal surgery by applying intraluminal occlusion for both caval veins. Methods From December 2002 to June 2012, 46 consecutive reoperative tricuspid valve operations were performed through a minimally invasive approach in the right fourth intercostal space without aortic cross-clamping, including 27 males and 19 females with ages between 13~67 years. TEE was used for monitoring and cooperation during the course of operations, estimating the degree of the TR, and guiding the occlusion of superior vena cava (SVC) and the inferior vena cava (IVC). Results All 46 patients underwent minimally invasive reoperative tricuspidal surgery successfully under the guidance of TEE. There were no cardiopulmonary bypass accidents during operations. The position and size of the balloons of two patients were readjusted to block caval veins completely under the guidance of TEE. The average time of operation was (161±52) min. The average time of building cardiopulmonary bypass (CPB) was (55±15) min and the average time of CPB was (58±23) min. TEE showed that all patients had no tricuspid incompetence during operations. Paravalvular leakage did not occur in tricuspid valve replacement (TVR).  All patients were successfully treated and discharged. Conclusion TEE can safely and reliably guide and monitor the operation when performing minimally invasive repeated isolated tricuspid valve surgery with vena cava intraluminal occlusion technique. Hence it has important application value.

Key words: transesophageal echocardiography, intraluminal occlusion, tricuspid valve surgery, repeated, minimally invasive surgery