Commissuroplasty for the anterior commissure defect caused by tricuspid valve endocarditis using patch closure and modified placement of a rigid ring

The anterior commissure defect of tricuspid valve may leave remnant regurgitation with inadequate leaflet coaptation after simple patch closure of the defect. A 19-year-old man underwent commissuroplasty for the anterior commissure defect caused by tricuspid valve endocarditis. Significant remnant regurgitation after patch closure of the anterior commissure defect was successfully solved by modified placement of an undersized rigid ring along the functional valve opening. The anterior horn of the rigid ring was affixed to the medial margin of the patch to reinforce the new commissure and enhance leaflet coaptation.