title: Indications for tricuspid valve detachment in closure of ventricular septal defect in children.
abstract: BACKGROUND
  Different techniques have been described for tricuspid valve detachment to improve visualization in ventricular septal defect repair. Our hypothesis was that preoperative echocardiographic criteria are important in deciding which patients should undergo ventricular septal defect repair by tricuspid valve detachment, and patients who undergo this procedure may have a better surgical outcome than those who fulfilled the criteria but were actually operated on with the standard surgical approach.
  
  
  METHODS
  Between January 2000 and December 2004 we prospectively studied 179 patients scheduled for ventricular septal defect repair and criteria for tricuspid valve detachment were established. Of these, 84 patients did not have any criteria for tricuspid valve detachment and were classified as the control group (group 1). Ninety-five patients with at least one criterion for tricuspid valve detachment were intraoperatively divided by patients who underwent tricuspid valve detachment into group 2 (n = 41), and those who did not undergo tricuspid valve detachment into group 3 (n = 53).
  
  
  RESULTS
  Surgical complications occurred more frequently in group 3 (26%) as opposed to group 2 (10%) and group 1 (7%). Residual ventricular septal defect and atrioventricular block occurred only in group 3. Tricuspid regurgitation occurred in 15% of group 3 versus 9.8% of group 2 and 7.1% of group 1.
  
  
  CONCLUSIONS
  Preoperative criteria for tricuspid valve detachment can be established before repair of ventricular septal defect. Patients who had indications for tricuspid valve detachment who actually had detachment performed during repair had fewer postoperative surgical complications as opposed to patients who fulfilled the criteria but did not undergo detachment.
authors.affiliation: Angela & Sami Shamoon Cardiothoracic Department, The Edith Wolfson Medical Center, Holon, Israel.
authors.forename: Lior
authors.initials: L
authors.lastname: Sasson
authors.forename: Michael G
authors.initials: MG
authors.lastname: Katz
authors.forename: Tiberiu
authors.initials: T
authors.lastname: Ezri
authors.forename: Akiva
authors.initials: A
authors.lastname: Tamir
authors.forename: Amir
authors.initials: A
authors.lastname: Herman
authors.forename: Edward L
authors.initials: EL
authors.lastname: Bove
authors.forename: Arie
authors.initials: A
authors.lastname: Schachner
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005260:Female; D006327:Heart Block / Q000453:epidemiology; D006345:Heart Septal Defects, Ventricular / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D011300:Preoperative Care; D011446:Prospective Studies; D012306:Risk; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000601:surgery*; D014262:Tricuspid Valve Insufficiency / Q000453:epidemiology; D014463:Ultrasonography