Tricuspid valve abnormalities in patients with atrioventricular discordance: surgical implications.
From 1975 to 1990, 90 patients (age, 6 months to 30 years; mean, 9.1 years) underwent operation for defects associated with atrioventricular discordance. Twenty-one had an anatomically abnormal tricuspid (systemic) atrioventricular valve (SAVV) of the following types: Ebstein, 11; straddling, 6; and dysplastic, 4. Sixteen valves were regurgitant: regurgitation was trivial to mild in nine and moderate to severe in seven. Two patients underwent a successful Fontan-type operation. None of the 5 patients with a competent SAVV underwent valve repair or replacement; 1 of these patients died. A ventricular septal defect was closed in 14 and an extracardiac valved conduit was placed in 7. Sixteen had a regurgitant valve: it was replaced in 10 and repaired in 2 (early mortality, 25%). All 4 patients who did not undergo repair or replacement of their regurgitant SAVV died. Two patients died late after repeat replacement. Four other reoperations (closure of a residual ventricular septal defect, SAVV replacement, left ventricle-to-pulmonary artery conduit replacement, and a redo Fontan procedure) were successful. Two patients are lost to follow-up, and 9 have been followed up for them 27 to 156 months (median, 117 months). All were well when last seen. We suggest that an abnormal regurgitant SAVV should be replaced. Alternatively, a "double-switch" procedure that leaves the tricuspid valve in the pulmonary circulation may be used.
Horvath
P
P
Cardiothoracic Unit, Hospital for Sick Children, London, England.
Szufladowicz
M
M
de Leval
M R
MR
Elliott
M J
MJ
Stark
J
J
D000293:Adolescent; D000328:Adult; D000792:Angiography; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D000013:Congenital Abnormalities / Q000145:classification / Q000175:diagnosis / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D007223:Infant; D008297:Male; D012086:Reoperation / Q000706:statistics & numerical data; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate; D014261:Tricuspid Valve / Q000002:abnormalities* / Q000503:physiopathology / Q000601:surgery; D014262:Tricuspid Valve Insufficiency / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology / Q000601:surgery*