title: Detachment of the anterior leaflet of the tricuspid valve to expose perimembranous ventricular septal defects.
abstract: BACKGROUND
  Detachment of the septal leaflet of the tricuspid valve has been described for better access to perimembranous ventricular septal defects. Detachment confined to the anterior leaflet is less known, although it provides a better exposure of the subaortic area and puts less jeopardy on the conduction tissues.
  
  
  METHODS
  Data regarding 49 consecutive patients who had congenital perimembranous ventricular septal defect closure were retrospectively reviewed. Thirty-three patients (67%) underwent temporary detachment of the anterior leaflet of the tricuspid valve. The defect was closed with a Gore-Tex patch and a continuous suture. In 10 patients (29%), concomitant right ventricular outflow tract enlargement was performed. Follow-up was obtained in every patient (median time, 11 months; range, 2 to 26 months).
  
  
  RESULTS
  No early or late death occurred. Closure of the ventricular septal defect was complete, with no more than trivial residual jet leaks found in perioperative echocardiography. All patients were in sinus rhythm. The tricuspid valve never showed more than mild insufficiency after repair. No patient showed subaortic obstruction.
  
  
  CONCLUSIONS
  Detachment of the anterior leaflet of the tricuspid valve to expose the ventricular septal defect is a safe approach that allows rapid closure of the defect with a continuous suture and provides excellent results.
authors.affiliation: Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland. silke53@gmx.de
authors.forename: Silke
authors.initials: S
authors.lastname: Maile
authors.forename: Alexander
authors.initials: A
authors.lastname: Kadner
authors.forename: Marko I
authors.initials: MI
authors.lastname: Turina
authors.forename: René
authors.initials: R
authors.lastname: Prêtre
mesh_terms: D019917:Blood Vessel Prosthesis Implantation; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006345:Heart Septal Defects, Ventricular / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011138:Polytetrafluoroethylene; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D013536:Suture Techniques; D014261:Tricuspid Valve / Q000601:surgery*; D014694:Ventricular Outflow Obstruction / Q000601:surgery
chemical_list: D011138:Polytetrafluoroethylene