Physiological approach to surgery for tricuspid atresia

Area of Science:

• Cardiovascular Surgery
• Pediatric Cardiology
• Congenital Heart Disease

Background:

• Tricuspid atresia presents significant challenges in surgical management.
• Previous shunting procedures were common in patients with complex congenital heart disease.
• Hypoplasia of the right ventricle is a key feature in tricuspid atresia.

Purpose of the Study:

• To evaluate a modified Fontan approach for tricuspid atresia.
• To assess the feasibility of creating a four-chambered heart in patients with tricuspid atresia.
• To determine the clinical and physiological outcomes of this surgical modification.

Main Methods:

• Surgical modification of the Fontan procedure using a valved conduit.
• Creation of right atrial-right ventricular continuity.
• Closure of atrial and ventricular septal defects.
• Enlargement of the right ventricular chamber.

Main Results:

• One operative death among nine patients.
• Eight survivors remained clinically well up to 3.5 years post-surgery.
• Postoperative cardiac catheterization showed normal atrial and pulmonary artery pressures.
• Angiography confirmed significant enlargement and pulsatility of the right ventricular chamber.

Conclusions:

• Establishment of a four-chambered, four-valved heart is feasible in many tricuspid atresia patients.
• The modified Fontan approach offers a viable surgical option.
• This technique demonstrates positive anatomic and physiologic outcomes.