Andersons pediatric cardiology 880
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FIG.33.19 Conereconstructionofthetricuspidvalve.Thedelamination
processstartswiththeanteriorleafletbeingincisedofftheannulus;
beginningatthe10o'clockposition,neartheleftretentionsuture.The
incisionisextendedclockwiseuntiltheleaflettissueends.Theanterior
leaflettissuecounterclockwisefromthe10o'clockpositionremains
attachedandwillserveasananchorpointforthereconstructedvalve.The
insetshowsmultiplefibrousandmuscularattachmentsbetweenthe
anteriorleafletandanteriorrightventricularfreewallinafour-chamber
orientationanddepictsthesecondstageofthesurgicaldelamination
process.Thisbeginsatthelevelofannulardetachmentandproceeds
apically.LV,Leftventricle;RA,rightatrium;RV,rightventricle.
FIG.33.20 Conereconstructionofthetricuspidvalve.Thesurgical
delaminationprocessiscompletewhenallattachmentsbetweenthesides
oftheleafletsandtherightventricularfreewallandventricularseptumare
divided.Theleafletshavebeen“peeled”awayfromtheventricular
myocardium.Whenthishasbeendonecorrectly,theonlyattachments
holdingtheleafletsintheventriclearethosechordaeoriginatingatthe
leadingedgesofthevalveleaflets.Thedottedlinetrianglemarksthe
smooth,nontrabeculatedinferiorwalloftherightventriclethatisatrialized.
FIG.33.21 Conereconstructionofthetricuspidvalve.Thedisplaced
septalleafletisbeingsurgicallydelaminatedandmobilized.Notethe
distancebetweentheproximalmobilizededgeandthetruetricuspid
annulus.
