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Tricuspid regurgitation (TR) is a frequent complication after heart transplantation. The etiology of TR is multifactorial, but biopsy-induced flail leaflet is one of the most important mechanisms. A 61-year-old woman underwent heart transplant, but experienced several rejection episodes which required multiple surveillance endomyocardial biopsies. At three months after transplant, she required tricuspid valve repair due to symptomatic severe TR. The anterior leaflet was flail, with rupture of primary and secondary chordae. Valve repair was performed with a triple leaflet edge-to-edge technique. The procedure consisted of suture fixation of the prolapsed anterior leaflet joining to the septal and posterior leaflets, and placement of a 30-mm annuloplasty ring. The patient was uneventfully discharged home on day 7 with trivial TR. At a four-years post-transplant evaluation, she was in NYHA functional class I, with preserved ventricular function and trivial TR. She has been followed closely because of post-transplant coronary artery disease.

Objective: To assess prospectively the impact of extracorporeal circulation on erectile function and the probable prognosis of future erectile function in patients undergoing myocardial revascularization surgery., Methods: 30 patients who met the following criteria were analyzed: a) age less than 80 years, b) elective surgery, c) use of extracorporeal circulation and d) stable partner. Pre-operative erectile function was determined and other cardiovascular risk factors by means of a written questionnaire. The patients were classified into three groups according to the preoperative erectile function: good (group A), fair (group B) and poor (group C). All patients underwent myocardial revascularization surgery., Results: 3 patients (27.2%) of group A reported poor erections after surgery, while 8 (72.7%) reported no changes in erectile function. Four patients (44.4%) of group B reported poor erection postoperatively, another 4 (44.4%) reported no significant changes in erectile function and 1 (11.1%) reported improvement in erectile function. One patient (10%) of group C reported improved erectile function, while the remaining patients reported no changes. To determine the influence of extracorporeal circulation and clamping time on erectile function as independent variables, the patients were classified into group I (patients of groups A and B that preserved or improved erectile function postoperatively) and group II (patients of groups A and B that reported poor erectile function postoperatively). The mean extracorporeal circulation time was 99 mins for group I and 116 mins for group II (p = 0.7102). The mean clamping time for group I was 56.84 mins and 69.57 mins for group II (p = 0.5375). No statistically significant differences were found (Wilcoxon test)., Conclusions: A) Patients with good erectile function undergoing myocardial revascularization surgery with extracorporeal circulation have a high probability of preserving the quality of erectile function postoperatively. B) Patients with erectile dysfunction are not likely to improve after myocardial revascularization surgery. C) Extracorporeal circulation and clamping times do not appear to influence the postoperative results. These were significantly shorter in patients that preserved or improved erectile function than in those that reported poor erectile function postoperatively and may be due to less intraoperative complexity. D) The preoperative erectile function was found to be the most important predictive factor of outcome. E) Further studies on larger series of patients are warranted to corroborate the foregoing findings.