OBJECTIVE: Congenital heart disease is often combined with tricuspid valve insufficiency, especially in adult patients. Valvuloplasty can effectively avoid valve replacement, which is important to reduce postoperative complications and improve long-term outcomes. This study focuses on the use of “edge-to-edge” valvuloplasty to correct tricuspid valve insufficiency in the setting of congenital heart disease. Methods: From January 2002 to December 2010, 24 patients with congenital heart disease combined with atrioventricular valve insufficiency underwent “edge-to-edge” valvuloplasty. The congenital heart malformations included atrioventricular canal malformation in 14 cases, secondary foramen ovale septal defect in 9 cases, and triple atrial heart in 1 case. RESULTS: There were no in-hospital deaths or postoperative complications. There were 20 cases with no or only minimal tricuspid valve insufficiency and 4 cases with mild regurgitation as measured by echocardiography at discharge. The follow-up ranged from 3 to 108 months (mean 52.4±25.6 months). Echocardiography showed no or minimal tricuspid valve insufficiency in 10 cases, mild insufficiency in 12 cases, and moderate insufficiency in 2 cases. There was no tricuspid stenosis. Conclusion: “Edge-to-edge” valvuloplasty is an effective adjunctive method to correct congenital heart disease combined with tricuspid insufficiency. Congenital heart disease is often combined with severe tricuspid valve insufficiency, especially in adult patients. The current clinical treatment of tricuspid insufficiency includes valvuloplasty and valve replacement. The surgical mortality rate and postoperative complications of tricuspid valve replacement are extremely high, and the literature reports that the surgical mortality rate of tricuspid valve replacement is 14.3%-24.5% (l-6). Tricuspid valvuloplasty remains the surgical procedure of choice for the treatment of tricuspid valve insufficiency. However, in severe tricuspid insufficiency with complex lesions, tricuspid valvuloplasty is sometimes extremely difficult, and postoperative residual tricuspid regurgitation and recurrence of tricuspid insufficiency still exist, requiring tricuspid valvuloplasty or tricuspid valve replacement again in some patients (4). It has been reported that “edge-to-edge” tricuspid valvuloplasty is an effective adjunctive method for the correction of severe residual tricuspid insufficiency (7-11). The clinical efficacy of tricuspid valve closure insufficiency was good in 24 patients with congenital heart disease combined with severe closure insufficiency using annuloplasty and “rim-to-rim” angioplasty from January 2002 to December 2010, which is summarized as follows: Data and methods: 24 patients in this group, 15 males and 9 females. The age was 10-60 years (mean 35.1±5.34 years). Congenital heart malformations included: atrioventricular canal malformation in 14 cases, secondary foramen ovale septal defect in 9 cases, and triple atrial heart in 1 case. All groups underwent tricuspid valvuloplasty under general anesthesia with hypothermic extracorporeal circulation, and myocardial protection was performed with cold-blooded myocardial arresting fluid by paracordaneous perfusion. The right atrial pathway was used to correct the intracardiac malformation first, and then the tricuspid valve was treated. The patient had a significantly enlarged tricuspid annulus, and tricuspid annuloplasty was first performed using a tricuspid valvuloplasty ring (hard or soft ring). Interrupted mattress sutures are used, starting on the left side of the posterior septal junction and continuing across the anterior septal junction, through the annuloplasty ring, and tied. After tricuspid annuloplasty, a right ventricular water injection test reveals significant tricuspid valve malalignment, and “edge-to-edge” valvuloplasty is used to correct tricuspid valve insufficiency. A traction line is placed at the free edge of the anterior, septal, or posterior leaflets where tricuspid regurgitation is evident. The right ventricle is filled with water to observe valve closure, and if closure is unsatisfactory, the suture site is changed or additional sutures are added to determine the optimal position of the “edge-to-edge” valvuloplasty suture. A 5-Prolene suture is passed through the midpoint of the free edge of the valve leaflet, and an interrupted mattress suture is performed to complete the “edge-to-edge” tricuspid valvuloplasty. The right ventricle was re-injected with water to check for residual regurgitation, and if residual regurgitation was present at the proximal edge of the valve leaflet, the leaflet was sutured directly to eliminate regurgitation, and the tricuspid orifice area was measured using a valvulometer and Hegar probe. Extracorporeal circulation was withdrawn, and epicardial echocardiography was applied to check tricuspid valve closure. All patients underwent cardiac echocardiography before discharge, and echocardiography was used to assess tricuspid valve function at follow-up. There were no in-hospital deaths or postoperative complications in the entire group. The echocardiographic measurements of tricuspid orifice area at discharge ranged from 2.8 to 3.6 cm2, with a mean of (3.2±0.4) cm2, and there were 20 cases of good tricuspid valve closure and 4 cases of mild regurgitation. The mean diastolic transvalvular pressure difference was 1.1-1.8 mmHg (mean 1.3±0.2 mmHg), and the pulmonary artery systolic pressure was 12-48 mmHg (mean 28.2±10.2 mmHg). There were no late deaths at 3-108 months follow-up, mean (52.4±25.6) months, 18 cases with NYHA class I cardiac function, 6 cases with class II, no tricuspid stenosis on echocardiography, 10 cases with good tricuspid valve closure, 12 cases with mild insufficiency, 2 cases with moderate insufficiency, mean transvalvular pressure difference in diastole 1.1-1.8 mmHg (mean 1.4±0.3 mmHg The mean diastolic transvalvular pressure difference was 1.1-1.8 mmHg (mean 1.4±0.3 mmHg); pulmonary artery systolic pressure was 11-47 mmHg (mean 18.3±9.8 mmHg). Discussion Congenital heart disease results in severe tricuspid valve insufficiency due to elevated pulmonary artery pressure and enlarged tricuspid annulus caused by prolonged left-to-right shunt, which is particularly common in adult patients. Residual tricuspid valve insufficiency and recurrence of tricuspid valve insufficiency are two important factors for their secondary surgery. Whereas the operative mortality rate of tricuspid valve replacement is as high as 24.5%, the survival rates at 5 and 10 years after surgery are 56-70% and 45-52% (l-6). Because thickening and calcification of the valve are rare in the tricuspid leaflet, it is suitable for valvuloplasty. Effective tricuspid valvuloplasty significantly reduces operative mortality and thrombosis, maintains long-term survival, and is significantly better than tricuspid valve replacement, making tricuspid valvuloplasty the preferred method for the treatment of tricuspid valve insufficiency. Traditional tricuspid valvuloplasty methods can satisfactorily resolve most tricuspid valve insufficiency. However, for some complex tricuspid valve lesions, because there is often an enlargement of the tricuspid annulus and abnormalities in the tricuspid valve membrane and subvalvular structures, the effect of conventional tricuspid valvuloplasty is not good, and some patients still have residual tricuspid valve insufficiency after surgery, the “edge-to-edge” tricuspid valvuloplasty method can be used as an adjunctive method to achieve more desirable The “edge-to-edge” tricuspid valvuloplasty method can be used as an adjunctive method to achieve more desirable treatment results (7-11). In this group, 20 cases had good tricuspid valve closure and 4 cases had mild tricuspid valve incompetence after surgery. The “edge-to-edge” valvuloplasty was first proposed by Alifieri, in which the prolapsed mitral leaflet is sutured to the corresponding anterior or posterior leaflet to form a double-port mitral valve. This method is simple, has a low operative mortality rate, and has become a routine surgical treatment for mitral valve prolapse because of the high rate of mitral valve surgery waivers. In recent years, this technique has been applied to severe tricuspid valve insufficiency with good results (7-11). However, the use of “edge-to-edge” valvuloplasty for congenital heart disease combined with severe tricuspid valve insufficiency and long-term outcomes have been less observed. We used this method to treat 24 patients with congenital heart disease combined with severe tricuspid valve insufficiency, and achieved satisfactory results with conventional tricuspid valvuloplasty combined with “edge-to-edge” valvuloplasty technique. We have learned that the following issues should be noted: 1. indications: 1. patients with atrioventricular canal malformation, after conventional tricuspid valvuloplasty with water injection test, the tricuspid valve still has regurgitation due to poor alignment of the anterior tricuspid valve leaflet and septal free edge. 2. adults with atrial septal defect secondary to foramen ovale, due to combined right ventricular dilatation, resulting in dilatation of the tricuspid annulus combined with leaflet prolapse. 3. after conventional tricuspid valvuloplasty, due to The tricuspid leaflet free edge is poorly aligned. 2, intraoperative precautions: 1, all patients should first use the forming ring to perform tricuspid annuloplasty, “edge-to-edge” surgery is only an adjunctive method should not be used alone. 2, in the regurgitation site leaflet free edge traction line, water injection filling the right ventricle to observe the state of the tricuspid valve, such as the closure is not satisfactory, replace the suture site or additional suture pre-set 3, Use the autologous pericardial spacer 5-prolene thread to cross the midpoint of the free edge of the valve leaflets and perform interrupted mattress suturing to complete the “edge-to-edge” tricuspid valvuloplasty. The suture tension at the suture site can be reduced to avoid tearing of the suture site and to reduce the occurrence of residual valve insufficiency. 4. The shaped right ventricle is re-injected with water to test the tricuspid valve alignment and the presence of residual regurgitation, if residual regurgitation exists at the leaflet edge. The valve leaflets can be sutured directly. In conclusion, if there is residual insufficiency after conventional tricuspid valve closure, “edge-to-edge” valvuloplasty technique can be effectively applied to tricuspid valvuloplasty with satisfactory surgical results, which is an important adjunct to valvuloplasty.