Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3740_Библиотеки_им_академика_М_И_Перельмана

The de Vega annuloplasty is a simple suture technique with which to narrow down the annulus of the tricuspid valve. Although it was the most common procedure to correct TR, it has largely fallen out of favour because of evidence of higher rates of recurrent tricuspid regurgita­tion, largely due to sutures cutting out of the imsy tricus­pid ‘annulus’, resulting in the return of annular enlargement and the ‘guitar string sign’ of sutures cross­ing the orice. This can be avoided by a slight modica­tion of the technique: the rst suture is taken inferiorly at the septal-posterior leaet commissure, with the second suture going back on itself to start at the midpoint of the rst suture (Figs.14.4 and 14.5). This is continued until the point where conduction tissue begins (X in the gure), then the course of the suture is reversed to anticlockwise and the suture line is completed in the same way back to the starting point. This results in a double line of cinching sutures that simply cannot cut out. In the overwhelming majority of cases, the annulus can be reduced to the desired diameter with two sutures lines as above. Where the annulus is enlarged to an exceptional degree, a third or even a fourth suture line may be needed.