Selective annuloplasty for tricuspid regurgitation in children

Tricuspid valve regurgitation occurs with other congenital heart defects, especially the right-sided obstructive lesions. We applied the selective annuloplasty technique for the treatment of tricuspid regurgitation in children.

Between 2001 and 2003, 15 patients whose ages averaged 7.6 +/- 3.1 years (range 4 to 17 years old) underwent selective annuloplasty during correction of other heart defects. The patients had repair of pulmonary stenosis (5 patients), pulmonary stenosis and ventricular septal defect (7 patients), and tetralogy of Fallot (3 patients). Eight patients preoperatively had moderate tricuspid regurgitation, and 7 patients had severe tricuspid regurgitation.

No deaths nor heart block occurred after the operation. The length of the tricuspid regutgitation flow was significantly decreased from 2.9 +/- 0.7 cm before the operation to 0.9 +/- 0.6 cm after the operation (p < 0.01), and the tricuspid annular diameter decreased from 3.9 +/- 0.3 cm to 3.3 +/- 0.3 cm (p < 0.01). Annular circumference was reduced by 1.9 +/- 0.2 cm. No tricuspid regurgitation was detected in 3 patients (20%), mild tricuspid regurgitation was seen in 10 (67%), moderate tricuspid regurgitation in 2 (13%). The right atrial mean pressure was significantly decreased from 7.5 +/- 0.5 mm Hg before the operation to 3.1 +/- 0.2 mm Hg after the operation (p < 0.01), right ventricular systolic pressure from 55.5 +/- 2.3 mm Hg to 29.8 +/- 1.9 mm Hg (p < 0.01), and right ventricular end-diastolic pressure from 8.4 +/- 0.7 mm Hg to 4.9 +/- 0.9 mm Hg (p < 0.01). Preoperatively, the degree of tricuspid regurgitation flow correlated significantly with the right ventricular systolic pressure (r = 0.89; p < 0.001). There was no correlation between tricuspid regurgitation flow and right ventricular systolic pressure postoperatively (p = 0.88). No child has symptomatic or significant tricuspid stenosis.

Selective annuloplasty presents a useful procedure for young patients with moderate or severe tricuspid regurgitation and right-sided obstructive lesions resulting from functional reconstruction of the tricuspid valve.