title: Outcomes of radial incision of the tricuspid valve for ventricular septal defect closure.
abstract: BACKGROUND
  Adequate exposure of a ventricular septal defect (VSD) is critically important to obtaining a satisfactory repair. Some surgeons have advocated a circumferential incision on the tricuspid valve. For 20 years we have used a radial incision of the tricuspid valve when added exposure is required.
  
  
  METHODS
  All patients undergoing VSD repair at Children's Memorial Hospital (Chicago, IL) were identified from our database. Operative records were reviewed to determine details of exposure. Follow-up patient and echocardiography data were obtained from the medical record.
  
  
  RESULTS
  Between January 1995 and March 2010, 366 isolated VSDs were repaired, including 341 perimembranous, 15 muscular, 5 inlet, and 5 inlet-muscular VSDs. A radial tricuspid valve incision was used in 230 patients (63%). Mean times (minutes) were 97±24 for cardiopulmonary bypass and 66±18 for cross-clamp, with no significant difference between groups (p=0.59 and p=0.96, respectively). No operative deaths occurred. Follow-up echocardiograms were available for 150 patients at a mean of 3.5 years. Tricuspid regurgitation was rated as none or trivial in 97 (65%), mild in 45 (30%), and moderate in 8 (5%). The degree of tricuspid regurgitation was similar between patients whose tricuspid valve was and was not incised.
  
  
  CONCLUSIONS
  Radial incision of the tricuspid valve enhances exposure for safe VSD closure and adds little complexity to the case. Its use in our series did not lead to increased tricuspid valve dysfunction, and it was durable at midterm echocardiographic assessment.
authors.affiliation: Division of Cardiovascular-Thoracic Surgery, Children's Memorial Hospital, and Northwestern University Feinberg School of Medicine, Chicago, Illinois 60614, USA. hrussell@childrensmemorial.org
authors.forename: Hyde M
authors.initials: HM
authors.lastname: Russell
authors.forename: Kirsten
authors.initials: K
authors.lastname: Forsberg
authors.forename: Carl L
authors.initials: CL
authors.lastname: Backer
authors.forename: Katherine C
authors.initials: KC
authors.lastname: Wurlitzer
authors.forename: Sunjay
authors.initials: S
authors.lastname: Kaushal
authors.forename: Constantine
authors.initials: C
authors.lastname: Mavroudis
mesh_terms: D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D002315:Cardiopulmonary Bypass; D002675:Child, Preschool; D015331:Cohort Studies; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006345:Heart Septal Defects, Ventricular / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D011138:Polytetrafluoroethylene; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D013536:Suture Techniques; D014261:Tricuspid Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging
chemical_list: D011138:Polytetrafluoroethylene