Minimally Invasive Tricuspid Repair in a Patient with Persistent Left Superior vena cava Using Three-Site Venous Drainage

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Severe tricuspid regurgitation, atrial flutter, and persistent left superior vena cava (PLSVC) (n=1). Intervention: Minimally invasive tricuspid valve repair and right atrial cryoablation using three-site venous drainage (RSVC, PLSVC, and femoral vein). Primary outcome: Resolution of tricuspid regurgitation and uncomplicated postoperative recovery.

Q: What does this research mean for the field?

Minimally invasive tricuspid valve repair using three-site venous drainage effectively treats severe tricuspid regurgitation and prevents coronary sinus backflow in patients with persistent left superior vena cava. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Ryoichi Tsuruhara; Yukihiro Hayatsu; Hayate Nomura; Naoya Terao; Masaki Hata

doi:10.4326/jjcvs.55.222

September 15, 2026Japanese Journal of Cardiovascular SurgeryOpen Access

Minimally Invasive Tricuspid Repair in a Patient with Persistent Left Superior vena cava Using Three-Site Venous Drainage

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Key result

Minimally invasive tricuspid repair with three-site drainage reduces torrential TR to mild.

n=1

Why the study?

Minimally invasive cardiac surgery (MICS) in patients with venous anomalies such as persistent left superior vena cava (PLSVC) requires modified venous drainage strategies, yet few reports describe detailed methods for this.

Does three-site venous drainage (RSVC, PLSVC, and IVC) enable safe and effective minimally invasive tricuspid valve repair in a patient with persistent left superior vena cava?

Key Points

Describe a surgical venous drainage strategy for minimally invasive tricuspid valve repair in a patient with persistent left superior vena cava.
Report of a 37-year-old male with severe tricuspid regurgitation, atrial flutter, and persistent left superior vena cava (PLSVC) without an innominate vein.
Minimally invasive tricuspid valve repair and cryoablation were conducted via right minithoracotomy using three venous drainage cannulas placed in the right superior vena cava, PLSVC, and right femoral vein.
Three-site cannulation established cardiopulmonary bypass without coronary sinus backflow, providing a clear operative field for annuloplasty and pericardial patch augmentation.
Tricuspid regurgitation was reduced to mild on postoperative day 8 echocardiography, and the patient was discharged without complications on postoperative day 10.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

Does three-site venous drainage (RSVC, PLSVC, and IVC) enable safe and effective minimally invasive tricuspid valve repair in a patient with persistent left superior vena cava?

P

Population

A 37-year-old male with torrential tricuspid regurgitation, atrial flutter, prior VSD patch closure, and persistent left superior vena cava, followed through hospital discharge on postoperative day 10.

I

Intervention

Minimally invasive cardiac surgery (MICS) via a 6 cm right mini-thoracotomy at the 4th intercostal space for tricuspid valve repair (annuloplasty with a 32 mm Contour 3D ring, spiral suspension, bovine pericardium patch mounting, and neochordae construction) and right atrial MAZE cryoablation, utilizing three-site venous drainage (16 Fr cannula in the right superior vena cava via right internal jugular vein, 14 Fr cannula in the PLSVC via left internal jugular vein, and a femoral vein cannula to the inferior vena cava) with right femoral artery perfusion.

O

Outcome

Operative field visualization and postoperative tricuspid regurgitation severity (reduced to mild TR on intraoperative TEE and postoperative day 8 TTE).surrogate

This case demonstrates that three-site venous cannulation (RSVC, PLSVC, and femoral vein) allows for a bloodless operative field and safe minimally invasive tricuspid valve repair in patients with a persistent left superior vena cava.

Limitations

Single case report representing only the second published report of three-site venous drainage for PLSVC, providing limited safety evidence
No direct comparison with median sternotomy or other surgical techniques, limiting assessment of relative efficacy
Performed at a center highly experienced in minimally invasive cardiac surgery, requiring careful evaluation before generalizing to other institutions
Single case report (second reported case of three-site venous drainage for PLSVC), so safety is based on limited evidence
Lack of direct comparison with other approaches such as median sternotomy
Performed at a center highly experienced in MICS, limiting generalizability
Need for established systematic monitoring protocols for broader generalization

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Implication

May facilitate minimally invasive tricuspid repair in persistent left superior vena cava; hypothesis-generating and requires larger series before wider adoption.

Abstract

胸骨温存小切開手術（MICS: minimally invasive cardiac surgery）は，正中切開と比較して低侵襲であり，輸血率，不整脈発生率，在院日数などにおいて優れている．左上大静脈遺残（PLSVC: persistent left superior vena cava）といった静脈奇形を有する患者でのMICSは脱血方式を工夫する必要があるが，その詳細な方法に言及した論文は少ない．今回PLSVCを有する患者で3本の脱血管を用いてMICS三尖弁形成術を行い良好な結果を得たため報告する．37歳男性．重症三尖弁閉鎖不全症，心房粗動，PLSVCに対してMICS三尖弁形成術，クライオアブレーションを右小開胸アプローチで施行した．右上大静脈，左上大静脈，右大腿静脈に脱血管を挿入し人工心肺を確立することにより，冠静脈洞からの逆流がなく良好な術野を得ることができた．逆流は制御でき，合併症なく術後10日で退院した．PLSVCを有する患者に3本の脱血管を使用し右小開胸での三尖弁形成術を行い良好な結果を得た．

Discussion

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Cite This Study

Tsuruhara et al. (2026) conducted a case report in Severe tricuspid regurgitation, atrial flutter, and persistent left superior vena cava (PLSVC) (n=1). Minimally invasive tricuspid valve repair and right atrial cryoablation using three-site venous drainage (RSVC, PLSVC, and femoral vein) was evaluated on Resolution of tricuspid regurgitation and uncomplicated postoperative recovery. Minimally invasive tricuspid repair using three-site venous drainage reduced torrential tricuspid regurgitation to mild, permitting uncomplicated discharge on postoperative day 10.

synapsesocial.com/papers/6af0e999de503f3774140a3f https://doi.org/10.4326/jjcvs.55.222

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Minimally Invasive Tricuspid Repair in a Patient with Persistent Left Superior vena cava Using Three-Site Venous Drainage

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Minimally Invasive Tricuspid Repair in a Patient with Persistent Left Superior vena cava Using Three-Site Venous Drainage

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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