Jaroslav Stark

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Retired paediatric cardiac surgeon. Worked at the University Hospital Prague, then Hospital for Sick Children, Great Ormond Street, London.Past president European Associan for Cardiothoracic Surgery

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Linda MacDonald Glenn

University of California, Santa Cruz

YIH-SHARNG CHEN

National Taiwan University

Peter Delobelle

University of Cape Town

Sri Novianty

University of Sumatera Utara

Phillip Tully

University of Adelaide

Luis Miguel Marques Pires

University of Coimbra

Murat Aksun

Izmir Katip Celebi

Stanislaw Bartus

Jagiellonian University in Krakow

Yuksel Atay

Ege University

Felix Ankel

University of Minnesota - Twin Cities

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A case for anatomic correction in atrioventricular discordance? Effects of surgery on tricuspid valve function

The Journal of Thoracic and Cardiovascular Surgery, Jun 1, 2001

To assess tricuspid valve function in atrioventricular discordance after palliative procedures (p... more To assess tricuspid valve function in atrioventricular discordance after palliative procedures (pulmonary artery banding and Blalock-Taussig shunt) and corrective procedures (anatomic and physiologic repair). Methods: Tricuspid valve dysfunction was assessed by transthoracic echocardiography and graded as no regurgitation (0), mild (1), moderate (2), and severe (3) before and after palliative and corrective procedures performed in 97 patients with atrioventricular discordance between 1988 and 1999. Thirty-two percent had an isolated ventricular septal defect, 43% had a ventricular septal defect and pulmonary stenosis, and 16% had pulmonary stenosis. Twenty-six patients underwent pulmonary artery banding and 28 had a Blalock-Taussig shunt. Seventy patients underwent physiologic and 19 underwent anatomic repair. Six patients underwent one-ventricle repair. Results: After pulmonary artery banding, the tricuspid regurgitation score decreased from 1.7 ± 0.8 to 0.9 ± 0.6 (P < .001). In patients who underwent a Blalock-Taussig shunt, the tricuspid regurgitation score increased from 0.7 ± 0.5 preoperatively to 1.4 ± 0.6 postoperatively (P < .001). After physiologic repair, there was no significant change in the tricuspid regurgitation score; however, 7 patients required additional repair or replacement. The regurgitation score was significantly reduced from 1.5 ± 0.8 to 0.4 ± 0.5 (P < .001) after anatomic repair. The operative mortality in patients who underwent physiologic repair was 7% as compared with 0% in the anatomic repair group (P = .59). The median follow-up was 3.2 years. Conclusions: Right ventricular volume loading (shunt) worsens tricuspid regurgitation, whereas volume reduction (banding) or left-to-right septal shift (anatomic repair) has beneficial effects. We have not observed a significant change in the tricuspid regurgitation score after physiologic repair. Anatomic repair can be performed in selected patients with atrioventricular discordance and provides superior functional results.

Jaroslav Stark

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