Tricuspid and Pulmonic Valve Repair and Replacement

The heart has four valves that control the flow of blood to the heart: the aortic, mitral, tricuspid and pulmonic (also called pulmonary) valves. The tricuspid valve lies between the right atrium and the right ventricle. The pulmonic valve is located between the right ventricle and the pulmonary artery.

Heart valve surgery is performed to repair a damaged or diseased heart valve. Two common abnormalities of heart valves occur when the heart valve does not close all the way (regurgitation) and when the valve does not open all the way (stenosis). These abnormalities can occur as a result of congenital abnormalities, heart attacks, age-related damage to the valves or infection.

Cardiac surgeons at the Brigham and Women's Hospital (BWH) Heart & Vascular Center have extensive experience performing tricuspid and pulmonic valve repair and replacement surgery. Their advanced training and collaboration with a multidisciplinary team of specialists through the Structural Heart Disease Program enables our surgeons to handle the most complicated cases, with a range of treatment options. In a complex, first-of-its-kind operation in 2012, BWH performed a transcatheter aortic valve replacement (TAVR) procedure on the tricuspid valve of a heart transplant patient.

With 47,000 outpatient visits each year, the Heart & Vascular Center is one of the largest in the United States, treating over 7,000 inpatients and performing more than 8,000 procedures annually at our state-of-the-art Shapiro Cardiovascular Center.

Tricuspid and Pulmonic Valve Repair and Replacement Topics

Tricuspid and Pulmonic Valve Repair Surgery

Cardiac surgeons at BWH's Heart & Vascular Center offer a variety of surgical techniques to enable heart valves to open and shut efficiently. Surgical approaches include the following:

  • Commisurotomy removes a valve leaflet that is too wide
  • Valvuloplasty uses a balloon to open a stenotic (stiff) heart valve
  • Ring annuloplasty tightens the ring supporting the valve (the annulus) by inserting an artificial ring made of metal, tissue or cloth around the valve

Surgery may also involve:

  • Decalcification to remove calcium to prevent leakage
  • Repair of structural support to reshape fibrous strings that support the valves
  • Patching holes to stop valve leakage
  • Reshaping a valve to allow it to open and close better
Tricuspid and Pulmonic Valve Replacement Surgery

When your surgeon determines that your heart valve cannot be repaired, he or she may recommend valve replacement surgery.

Replacement Valves

Damaged heart valves are replaced with a choice of substitute valves including:

  • Mechanical valves made of durable synthetic materials such as graphite and pyrolytic carbon. These last as long as 30 years and recipients must take lifelong blood thinning medications.
  • Biological valves last for 10 to 20 years and are made from animal tissue or donated human tissue. A homograft is a valve from a donated human heart. Patients do not require long-term blood thinning medications.
Open or Minimally Invasive Tricuspid or Pulmonic Valve Surgery

Valve repair or replacement surgery may be performed with traditional (open) heart surgery or minimally invasive surgery. Surgeons in the Heart & Vascular Center use their advanced training and experience to perform varied surgical options – unique to each patient - when operating on heart valves.

Open heart surgery means cutting skin and tissues with a wide incision so that your surgeon has a full view of your heart. Types of open surgery are:

  • Sternotomy involves a nine-inch incision made down the center of your chest separating your breastbone.
  • Thoracotomy involves a nine-inch incision made in your rib cage from under the arm around to the back.

Minimally invasive heart surgery uses small incisions and has fewer post-operative complications, allowing patients to recuperate faster with less pain. These include:

  • Mini thoracotomy uses a small incision through the ribs
  • Mini sternotomy is done through a small opening that goes from the top of your breastbone down to the third rib.

Percutaneous Intervention

Cardiac surgeons and interventional cardiologists work closely with cardiologists to perform percutaneous (needle puncture of the skin) techniques, often recommended for elderly and medically-fragile patients. This includes:

Transcatheter Aortic Valve Replacement (TAVR) may be recommended for high-risk patients with aortic valve stenosis who cannot tolerate open chest surgery. A catheter is inserted in the upper leg and guided into the heart chambers, where a balloon is inflated to open up the diseased aortic valve. The catheter is removed and a second catheter, with a synthetic valve crimped around a deflated balloon, is moved into the dilated opening. After positioning the catheter, the surgeon inflates the balloon to expand the new valve and secure it into place.

Read this article about BWH's first transcatheter valve replacement of the tricuspid valve.

Learn more about heart valve repair and replacement surgery.

Why Have Tricuspid or Pulmonic Valve Repair or Replacement?

Valve repair or replacement surgery corrects the problems caused by one or more diseased heart valves. You may need surgery if:

  • You have regurgitation
  • You have stenosis
  • Your valve has developed an infection (endocarditis)
  • You have heart symptoms, such as chest pain, shortness of breath, fainting spells or heart failure
  • You have edema (swelling) or weight gain due to fluid retention
  • Tests show that the changes in your tricuspid or pulmonic valve are affecting heart function

Learn more about heart valve disease.

What You Should Expect

The Heart & Vascular Center is located in the Shapiro Cardiovascular Center, across the street from BWH's main 75 Francis Street entrance. The Heart & Vascular Center brings together the full range of services in one location, fostering seamless and coordinated care for all cardiovascular patients.

Prior to surgery, you will be scheduled for a visit to the Watkins Clinic in the Shapiro Cardiovascular Center for preoperative information and tests.

The day of surgery, your care will be provided by surgeons, anesthesiologists and nurses who specialize in valve disease. The Heart & Vascular Center is home to one of the most advanced hybrid operating rooms in the country. After surgery, you will recover in the post-surgical care unit where you will receive comprehensive care by an experienced surgical and nursing staff.

During your surgery, family and friends can wait in the Shapiro Family Center where staff members will provide surgery updates.

Multidisciplinary Care

In addition to our cardiac surgeons, patients also benefit from the teamwork of medical cardiologists, interventional cardiologists, cardiovascular imaging experts and radiologists, and anesthesiologists, all experts in cardiovascular disease. They work alongside nurses, physician assistants, physical therapists, dietitians and social workers to achieve outstanding outcomes for our patients.

Resources

Learn more about heart valve repair and replacement surgery in our health library.

Visit the Kessler Health Education Library in the Bretholtz Center for Patients and Families.

Access a complete directory of patient and family services.

Learn about the Watkins Clinic in the Shapiro Cardiovascular Center.

Download Cardiac Surgery: A Guide for Patients in English or Spanish.

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