title: Tricuspid valve regurgitation in congenitally corrected transposition of the great arteries and a left ventricle to pulmonary artery conduit.
abstract: BACKGROUND
  The configuration of the interventricular septum can affect the function of the tricuspid valve in patients with congenitally corrected transposition of the great arteries who have a systemically functioning right ventricle. Altering septal configuration by addressing a dysfunctional conduit placed between the left ventricle (LV) and the pulmonary artery (PA) in these patients can impact septal configuration and competency of the tricuspid valve.
  
  
  METHODS
  In 38 patients with an LV to PA conduit, we evaluated relationships between conduit function, RV geometry, and tricuspid valve function, and compared these variables before and after conduit intervention.
  
  
  RESULTS
  Median age at conduit implant was 4.5 years (0.5 to 36) and median total follow-up was 12 years (2 to 22). Of the 38 patients, 23 (60%) underwent conduit intervention, a median of 7.5 years after implant. In 15 of these patients (65%) the degree of tricuspid regurgitation (TR) worsened, compared with only 2 patients (15%) in the non-intervention group (p < 0.001). Worsening TR was associated with the degree of change in RV and LV ventricular diameters, change in tricuspid annulus size and tethering distance, and the degree of septal shift, as reflected by the right ventricular sphericity index (all p ≤ 0.04). In 8 of 15 patients with more severe TR at follow-up, there was also progressive RV dysfunction.
  
  
  CONCLUSIONS
  Intervention for LV to PA conduit dysfunction may result in worsening TR and right ventricular function, likely due in part to altered septal shift due to changes in the interventricular pressure ratio. Management of LV to PA conduit dysfunction should take these findings into account.
authors: Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Cardiology, Nationwide Children's Hospital, Ohio state University, Columbus, Ohio. Electronic address: yonibuber@gmail.com.
authors: Jonathan
authors: J
authors: Buber
authors: Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Lucile Packard Children's Hospital, Stanford University, Palo Alto, California.
authors: Doff B
authors: DB
authors: McElhinney
authors: Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.
authors: Anne Marie
authors: AM
authors: Valente
authors: Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.
authors: Audrey C
authors: AC
authors: Marshall
authors: Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.
authors: Michael J
authors: MJ
authors: Landzberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D058385:Cardiac Valve Annuloplasty / Q000379:methods; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000601:surgery*; D006801:Humans; D007223:Infant; D016014:Linear Models; D008297:Male; D011651:Pulmonary Artery / Q000601:surgery*; D012016:Reference Values; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D014188:Transposition of Great Vessels / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D055815:Young Adult