title: Novel method for evaluating tricuspid valve function after tricuspid valve detachment in the repair of perimembranous ventricular septal defects.
abstract: Tricuspid valve detachment has been used for decades in the repair of type II ventricular septal defects (VSDs); however, the procedure can damage the tricuspid valve and conduction system. We retrospectively reviewed 177 consecutive type II VSD repairs performed at our hospital from 1997 through 2004. Patients were included if they had symptoms, pulmonary hypertension, or a Qp/Qs ratio>1.5: 86 underwent tricuspid valve detachment (TVD group) and 84 underwent VSD repair without this detachment (non-TVD group). There was no significant difference between groups in age, body weight, VSD size, Qp/Qs ratio, follow-up duration, or incidence of residual shunting. Cross-clamp times (109.6±42.6 vs 92.2±38.1 min) and cardiopulmonary bypass times (155.1±53.8 vs 137±47 min) were longer in the TVD group. No patients developed tricuspid stenosis or heart block. After excluding patients who underwent tricuspid repair, we found similar grades of postoperative tricuspid regurgitation in both groups. In applying our novel criterion (last postoperative regurgitation grade minus preoperative regurgitation grade) to evaluate changes between preoperative and postoperative tricuspid regurgitation, we found significant deterioration in the non-TVD group (P=0.018). Had conventional evaluation methods been used, severity in the groups would not have differed significantly. Our method enables additional evaluation of late tricuspid function in individual patients. Tricuspid valve detachment is safe for type II VSD repair and has no adverse effect on late tricuspid valve function. In addition, we recommend the interrupted-suture technique for leaflet reattachment.
authors.affiliation: Division of Pediatric Cardiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung City 833, Taiwan, Republic of China.
authors.forename: Ying-Jui
authors.initials: YJ
authors.lastname: Lin
authors.forename: Jen-Ping
authors.initials: JP
authors.lastname: Chang
authors.forename: Shao-Ju
authors.initials: SJ
authors.lastname: Chien
authors.forename: Chi-Di
authors.initials: CD
authors.lastname: Liang
authors.forename: Chien-Fu
authors.initials: CF
authors.lastname: Huang
authors.forename: Chiung-Lun
authors.initials: CL
authors.lastname: Kao
mesh_terms: D000369:Aged, 80 and over; D006328:Cardiac Catheterization; D006348:Cardiac Surgical Procedures / Q000379:methods*; D018618:Echocardiography, Doppler, Color; D005260:Female; D005500:Follow-Up Studies; D006345:Heart Septal Defects, Ventricular / Q000150:complications / Q000601:surgery*; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013536:Suture Techniques; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D014264:Tricuspid Valve Stenosis / Q000150:complications / Q000601:surgery*
keywords: Follow-up studies; heart defects, congenital/surgery; heart septal defects, ventricular/surgery; tricuspid valve/physiopathology/surgery