Case report: Surgical valvular pulmonary reconstruction for a previous unreported rheumatic right-sided valve disease with severe pulmonary regurgitation

Figures

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  Figure 1. Transthoracic echocardiogram (TTE) pre-operation revealing the presence of severe pulmonary stenosis with the contracture of the pulmonary annulus and valves but with no sign of RVOT stenosis (A), RA enlargement, severe tricuspid regurgitation (B, arrow) and pulmonary regurgitation (C). Transesophageal echocardiography (TEE) immediately before surgery revealing severe pulmonary valvular insufficiency in the cardiac end diastolic period and end systolic period (D, arrow). LA, left atrium; PA, pulmonary artery; RA, right atrium; RPA, right pulmonary artery; RV, right ventricle; RVOT, right ventricular outflow tract; TV, tricuspid valve.

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  Figure 2. Intraoperative view showing a small pulmonary annulus (A), rheumatic tricuspid stenosis with regurgitation (B) and pulmonary regurgitation with valvular contracture (C). A bileaflet bovine pericardial patch was then tailored (D) and used for reconstruction of the pulmonary trunk with the leaflets at the same high level (E, arrow). The diameter of the reconstructed pulmonary was 20 mm (F). The operation was completed (G). BBP, bovine pericardial patch; PA, pulmonary artery; RA, right atrium; RV, right ventricle; RVOT, right ventricular outflow tract; TV, tricuspid valve.

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  Figure 3. Histopathology of the tricuspid valve showed fibrous tissue hyperplasia with hyalinosis (A), mucoid degeneration (B) and the infiltrated lymphocytes (C). H&E staining, ×10 for panel A and ×40 for panel B,C.

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  Figure 4. Transthoracic echocardiogram (TTE) at discharge (8 days post-surgery) indicated that the leaflets functioned well in both the cardiac phase of end systolic (A) and diastolic (B), with only mild regurgitation (C,D).