Factors associated with development of atrial septal restriction in patients with tricuspid atresia involving the right-sided atrioventricular valve.
BACKGROUND
Clinical practice is discrepant regarding routine enlargement of the interatrial communication (IAC) in patients with right-sided atrioventricular valve atresia. We determined the percentage and risk factors of those who develop a restrictive IAC.


METHODS
Medical records were reviewed for patients treated from 1985 to 2006, including those admitted in the first 6 weeks of life (group A), and those referred at a later age (group B), some of whom had routine atrial septal procedures. In group A, we analyzed the initial postnatal echocardiogram.


RESULTS
Group A consisted of 79 patients, 16 of whom had an atrial septectomy as part of the initial surgical procedure. Of the remaining 63 patients, 9 (14%) developed atrial septal restriction. In group A, an atrial septal aneurysm (ASA) (OR 16, P = .006) and IAC diameter < 5 mm (OR 13, P = .009) were associated with atrial septal restriction. Atrial septal restriction occurred in 80% of patients with both features, 20% with IAC > or = 5 mm and ASA, 18% with IAC < 5 mm and no ASA, and 2% with neither feature. Group B consisted of 95 patients, 27 of whom had an atrial septal procedure. Of the remaining 68 patients, 11 (16%) developed atrial septal restriction.


CONCLUSIONS
Routine enlargement of the IAC is not necessary in patients with right-sided atrioventricular valve atresia. Patients with ASA or IAC < 5 mm are at increased risk for development of atrial septal restriction.
Tzifa
Aphrodite
A
Department of Cardiology, Children's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Gauvreau
Kimberlee
K
Geggel
Robert L
RL
D000293:Adolescent; D054087:Atrial Septum / Q000473:pathology / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D005500:Follow-Up Studies; D054092:Foramen Ovale, Patent / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D012307:Risk Factors; D018785:Tricuspid Atresia / Q000000981:diagnostic imaging / Q000503:physiopathology