Tricuspid valve repair is feasible in patients with congenital absence of the left thoracic pericardium, and increased positive end expiratory pressure can assist in weaning from cardiopulmonary bypass by maintaining orthotopic heart positioning.
We present a case of severe tricuspid valve insufficiency because of disruption of the anterior tricuspid leaflet with congenital absence of left thoracic pericardium. Findings suggest that tricuspid valve disruption was a result of distorted right ventricular geometry because of luxation of the heart into left thoracic cavity. Tricuspid valve could be repaired by reinsertion of anterior tricuspid leaflet and De-Vega annuloplasty. Normal hemodynamic was obtained and weaning from cardio pulmonary bypass was possible by lifting the heart in orthotopic position using increased positive end expiratory pressure. Postoperative course was uneventful.
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Wolfgang A. Goetz (2004) studied this question.
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