Repair of Major Intracardiac Anomalies Associated with Atrioventricular Discordance

Williams, William G.; Suri, Roger; Shindo, G; Freedom, Robert M.; Morch, John E.; Trusler, George A.

doi:10.1016/s0003-4975(10)61343-4

Cited by 43 publications

(12 citation statements)

References 10 publications

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“…As have others,10 11 we have observed a high incidence of tricuspid regurgitation induced by the conventional surgical protocols. We do not think this is a result of a direct lesion of the valvar system during the operation, but rather that the fall in left ventricular pressure after closure of the ventricular septal defect may have modified the geometry of the septum, causing attraction of the septal leaflet of the tricuspid valve towards the left ventricle and distorting the other leaflets, especially if the septal leaflet was attached to the septum as in Ebstein’s malformation.…”

Section: Discussionsupporting

confidence: 69%

Maintaining tricuspid valve competence in double discordance: a challenge for the paediatric cardiologist

Acar

Sidi

Bonnet

et al. 1998

Heart

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Objectives-To establish the prevalence of tricuspid valve abnormalities in children with a double discordant heart (or congenitally corrected transposition of the great arteries); to study the influence of the loading conditions induced by various surgical interventions on the right and left ventricle in patients with double discordance and an abnormal tricuspid valve; and to propose a rational surgical approach. Methods-Case notes were reviewed of 141 consecutive patients admitted in the first year of life with various types of double discordance (intact ventricular septum (group 1), ventricular septal defect (group 2), ventricular septal defect and pulmonary obstruction (group 3)). A study group of 62 patients with an abnormal tricuspid valve was selected by cross sectional echocardiography. These were followed up through palliative and open heart procedures with grading of tricuspid regurgitation. Results-Tricuspid valve abnormalities were more common in groups 1 and 2 (60% and 56%) than in group 3 (31%). Preoperative tricuspid regurgitation was more common in group 2 (90%) than in groups 1 and 3 (38% and 36%). Ten patients in groups 1 and 2 died in the neonatal period with severe tricuspid regurgitation, associated with coarctation of the aorta in 60%. Eight patients in group 1 had no surgery and are doing well, with a competent tricuspid valve. Palliative procedures were undertaken in 28 patients: 14 had pulmonary artery banding, which resulted in a decrease in tricuspid regurgitation, 12 in group 2 by reducing the pulmonary blood flow and two in group 1 by changing the septal geometry; 14 in group 3 had an aortopulmonary shunt, which induced tricuspid regurgitation in two. Twenty patients are still alive after palliation, with stable tricuspid valve function. Repair of the tricuspid valve was unsuccessful in the three patients who underwent conventional surgery, leaving the right ventricle facing the systemic circulation. In two patients with a competent but abnormal tricuspid valve, conventional surgery induced severe tricuspid regurgitation. Of the 15 patients who underwent conventional surgery, only 10 survived (mortality 33%): eight with a tricuspid valve prosthesis and two with severe residual tricuspid regurgitation. However, tricuspid regurgitation decreased after anatomical correction (nine patients), restoring a systemic left ventricle and a subpulmonary right ventricle, even when the tricuspid valve was not repaired (five patients). Eight patients are doing well after anatomical correction (mortality 11%). (Heart 1998;80:479-483) Conclusions-Tricuspid

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Section: Discussionsupporting

confidence: 69%

Maintaining tricuspid valve competence in double discordance: a challenge for the paediatric cardiologist

Acar

Sidi

Bonnet

et al. 1998

Heart

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“…Several investigators have noted the development or exacerbation of TI shortly after open heart surgery for closure of a ventricular septal defect (VSD) with or without pulmonic stenosis (PS), 2,3,7,8 whereas others have not found such a relation. 6,9 No series to date has carefully defined the progression of TV disease in operated as well as unoperated patients in order to establish the role of open heart surgery and other potential risk factors in the natural history of this disease. This study examines the long-term course and outcome of patients with CTGA with and without open heart surgery with particular attention to the status of the TV.…”

mentioning

confidence: 99%

Progressive Tricuspid Valve Disease in Patients With Congenitally Corrected Transposition of the Great Arteries

et al. 1998

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Background-The outcome of patients with corrected transposition of the great arteries (CTGA) is variably affected by associated intracardiac defects, tricuspid valve competence, and systemic right ventricular (RV) function. The relative importance of these factors in long-term outcome has not been evaluated. Methods and Results-Since 1958, 40 patients with CTGA were studied to determine risk factors for poor outcome,including age, open heart surgery, tricuspid insufficiency (TI), cardiac rhythm, pulmonary overcirculation, and RV dysfunction. Follow-up ranged from 7 to 36 years (mean 20 years). Intracardiac repair was performed in 21 patients; 19 were unoperated or had closed heart procedures. For the purposes of this study the designation TI s refers to at least moderately severe TI as delineated by echocardiogram and/or angiography. TI s was the only independently significant factor for death (Pϭ0.01), and in turn, only the presence of a morphologically abnormal TV predicted TI s (Pϭ0.03). Twenty-year survival without TI s was 93%, but only 49% with TI s . Poor long-term postoperative outcome was due to TI s in all but 1 patient; 20-year survival rates for operated patients with and without TI s were 34% and 90%, respectively (Pϭ0.002). Similarly, 20-year survival rates for unoperated patients with and without TI s were 60% and 100%, respectively, whether or not attempts to repair the TI were made (Pϭ0.08). Conclusions-TI s represents the major risk factor for CTGA patients; RV dysfunction appears to be almost always secondary to long-standing TI. Decisions related to surgical interventions with or without associated lesions must be strongly influenced by the status of the tricuspid valve. (Circulation. 1998;98:997-1005.)

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“…5,6,9 Debate continues as to whether repair or replacement in these patients is better, but the overall consensus is that complex valve pathologies should be replaced. The rate of valve repair failure in these patients has been previously reported to be as high as 50%, 14,15 which may in part be secondary to the ventricular disease in these patients in addition to the frequently noted valvular dysplasia.…”

Section: Commentmentioning

confidence: 85%

“…Several studies have examined patients with ccTGA requiring surgical intervention with cohorts varying from 16 to 44 patients. [4][5][6][7][8][9]14,15 The majority of these patients had not undergone previous intervention, but some studies included patients who had undergone anatomic, physiologic, and singleventricular repairs. 4,7,8 As a whole, these studies have shown that intervention prior to the development of significant systemic ventricular dysfunction (EF <40%) improves outcomes.…”

Section: Commentmentioning

confidence: 99%

Outcomes and Prognostic Factors for Adult Patients With Congenital Heart Disease Undergoing Primary or Reoperative Systemic Atrioventricular Valve Surgery

Han

Ginns

Rosenbaum

et al. 2017

World J Pediatr Congenit Heart Surg

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Repair of Major Intracardiac Anomalies Associated with Atrioventricular Discordance

Cited by 43 publications

References 10 publications

Maintaining tricuspid valve competence in double discordance: a challenge for the paediatric cardiologist

Maintaining tricuspid valve competence in double discordance: a challenge for the paediatric cardiologist

Progressive Tricuspid Valve Disease in Patients With Congenitally Corrected Transposition of the Great Arteries

Outcomes and Prognostic Factors for Adult Patients With Congenital Heart Disease Undergoing Primary or Reoperative Systemic Atrioventricular Valve Surgery

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