Congenital Flail Tricuspid Valve Leaflet, A Challenging Surgical Decision. Case Report, and Literature Review

Author(s): Ali A. Alakhfash, Khaled Alhawri, Abdullah Alqwaiee, Abdulrahman Almesned, Bana Nasser, Marwan Alhawbani, Mohammed Hasab Elnabi

Background: Congenital severe tricuspid valve (TV) insufficiency secondary to ruptured papillary muscle or ruptured chordae tendineae is very uncommon. Ruptured chordae and/or papillary muscle will lead to flail leaflet and tricuspid insufficiency, the severity of which depends upon the severity of the affected leaflet(s). The neonatal presentation might simulate that of severe Ebstein anomaly of the TV, with severe cyanosis due to reduced pulmonary blood flow. Compared to Ebstein anomaly, there is no apical displacement of the tricuspid valve leaflets.

Case presentation: We are presenting a neonate with refractory neonatal cyanosis immediately after birth due to congenital flail TV leaflets. A successful surgical repair of the TV improved the TV function with excellent immediate, short and midterm outcomes.

Conclusions: TV repair is the best surgical option for TV dysplasia with ruptured chordae and flail leaflets, with good immediate as well as short and mid-term outcomes.