Why the study?
In tricuspid valve repair for situs inversus totalis, inverting a standard rigid ring risks improper leaflet coaptation due to three-dimensional anatomical geometry.
Using a flexible band instead of an inverted 3D rigid ring for tricuspid annuloplasty in patients with situs inversus totalis prevents poor leaflet coaptation due to the unique anatomical orientation.
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Flipping rigid rings risks poor coaptation in situs inversus tricuspid repair; case report leaves open whether flexible bands are preferable.
三尖弁は非対称的な3次元構造であり，posteroseptal portionが最も心尖部寄りにあり，anteroseptalportionが最も心尖部から遠くにある．完全内臓逆位では心腔内構造は正常解剖心の鏡像となるが，posteroseptal portionが最も低い位置に，anteroseptal portionが最も高い位置にあることは変わらない．そのため完全内臓逆位の症例における三尖弁形成術において，通常使用される3次元構造のrigid ringを裏返して使用するとposteroseptal portionが高い位置にanteroseptal portionが低い位置に誘導され，弁尖のcoaptationが不良になる恐れがある．今回，右胸心，完全内臓逆位における三尖弁閉鎖不全症，僧帽弁閉鎖不全症，慢性心房細動に対してflexible bandを用いた三尖弁輪縫縮術，僧帽弁形成術，左房縫縮術，左心耳閉鎖術を施行したので文献的考察を加えて報告する．
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Shimada et al. (2023) studied this question.
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