title: Liberal use of tricuspid valve detachment for transatrial ventricular septal defect closure.
abstract: BACKGROUND
  Although temporary tricuspid valve detachment is useful for improved visualization of ventricular septal defect through right atriotomy, liberal use of this adjunct is not widely supported, mainly because of concerns about iatrogenic complications such as heart blocks and tricuspid valve dysfunction. The objective of this study was to determine whether liberal use of this adjunct can improve operative outcome.
  
  
  METHODS
  Between January 1997 and March 2002, trans-atrial closure of isolated ventricular septal defect (conoventricular or canal type) was performed in 87 consecutive patients. Tricuspid valve detachment was used in 4 out of 44 patients (prudent-use group) and 19 out of 43 patients (liberal-use group) in the first and second half of this period, respectively (p = 0.0002). Patient demographics and use of other surgical and cardiopulmonary bypass techniques remained virtually unchanged during this period.
  
  
  RESULTS
  In the prudent-use group, there was one operative death with prolonged bypass time and one residual defect that required reoperation; neither of these patients underwent tricuspid valve detachment. All other patients (both groups) were free from mortality and clinically significant complications, including heart block, tricuspid regurgitation, and residual defect. The liberal-use group had shorter cardiopulmonary bypass time than the prudent-use group (59 +/- 14 vs 67 +/- 22 minutes, p = 0.037).
  
  
  CONCLUSIONS
  Tricuspid valve detachment should be used liberally for moderate- or even low-difficulty exposure of ventricular septal defect, regardless of patient background, because it is a safe and effective adjunct that can improve speed, programmability, reproducibility, and reliability.
authors.affiliation: Division of Cardiovascular Surgery, Keio University, Tokyo, Japan. aeba@sc.itc.keio.ac.jp
authors.forename: Ryo
authors.initials: R
authors.lastname: Aeba
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Katogi
authors.forename: Kenichi
authors.initials: K
authors.lastname: Hashizume
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Koizumi
authors.forename: Yoshimi
authors.initials: Y
authors.lastname: Iino
authors.forename: Mitsuharu
authors.initials: M
authors.lastname: Mori
authors.forename: Ryohei
authors.initials: R
authors.lastname: Yozu
mesh_terms: D000293:Adolescent; D006348:Cardiac Surgical Procedures / Q000379:methods; D002315:Cardiopulmonary Bypass; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000601:surgery*