[Tricuspid regurgitation after corrective surgery of ventricular septal defect: evaluation using pulsed Doppler echocardiography].
Using two-dimensional (2DE) and pulsed Doppler echocardiography (PDE), the prevalence, cause, and 2DE findings of tricuspid regurgitation (TR) occurring after corrective surgery for ventricular septal defect (VSD) were investigated. Fifty-one postoperative patients (25 boys and 26 girls) ranging in age from 2 months to 11 years and 9 months were studied. There were 23 preoperative patients with VSD and 26 children without cardiac disorders who served as controls. TR was diagnosed when pansystolic abnormal Doppler signals were obtained in the right atrial cavity by PDE. Twenty-three (45.1%) of the 51 postoperative patients, two (8.7%) of 23 preoperative patients, and none of 26 normal subjects were found to have TR. The prevalence of TR in postoperative patients was significantly (p less than 0.01) greater than those of the two control groups, but there was no significant difference between the control groups. The prevalence of TR was not relevant to sex or type of VSD, but TR was detected more frequently in patients with residual shunts (p less than 0.01), in those with postoperative pulmonary hypertension (p less than 0.01), and in those with morphological abnormalities of the tricuspid valve (p less than 0.01). In postoperative patients, the mean age at surgery of those with TR (mean +/- SD = 18.3 +/- 17.4 months) was younger than that of those without TR (29.9 +/- 21.4), and the cardiothoracic ratio (0.59 +/- 0.07 and 0.55 +/- 0.07, respectively), tricuspid annulus size (122 +/- 19 and 104 +/- 10% of normal), and right atrial size (143 +/- 34 and 106 +/- 12% of normal) were greater in patients with TR. The maximal extent of the TR signal correlated positively with right atrial size and tricuspid annulus size, and seemed to be a useful index for evaluating the severity of TR. Abnormal morphological findings of the tricuspid valve detected by 2DE were (1) no coaptation of the anterior and septal leaflets in systole (= discoaptation), (2) no coaptation of both leaflets throughout the cardiac cycle (= valve defect), and (3) apical displacement of the valve in systole (= bulging). (1) and (2) appeared to be associated with TR produced by operative injury; and (3), with functional TR. It was concluded that TR occurs frequently after corrective surgery for VSD, and 2DE and PDE were useful for evaluating the cause and severity of TR.
D002648:Child; D002675:Child, Preschool; D004452:Echocardiography / Q000379:methods; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis*; D014262:Tricuspid Valve Insufficiency / Q000175:diagnosis* / Q000209:etiology