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Atrial morphologic features in tricuspid atresia
D G Thoele1, P C Ursell, S Y Ho
1Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, N.Y.
The Journal of Thoracic and Cardiovascular Surgery
|October 1, 1991
Summary
This study examined atrial morphology in patients with tricuspid atresia, finding common prominent eustachian valves and variations in interatrial communications. Right atrial hypertrophy was significant in restrictive cases and after Fontan operations.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Tricuspid atresia is a complex congenital heart defect requiring specialized surgical interventions.
- Understanding atrial morphology is crucial for managing patients with tricuspid atresia and predicting outcomes.
- The Fontan operation is a palliative procedure for single-ventricle defects, and atrial anatomy can influence its success.
Purpose of the Study:
- To investigate the detailed atrial morphology in a cohort of patients with tricuspid atresia.
- To compare atrial findings in tricuspid atresia patients with normal hearts.
- To assess the implications of specific atrial features, such as interatrial communications and atrial appendage juxtaposition, on patient management and surgical outcomes, particularly the Fontan operation.
Main Methods:
- Autopsy examination of 110 hearts from patients with tricuspid atresia.
- Comparison with 30 normal hearts.
- Detailed analysis of atrial structures, including eustachian valves, interatrial communications, and atrial appendage positioning.
- Measurement of right atrial wall thickness to quantify hypertrophy.
Main Results:
- Prominent eustachian valves were observed in 40% of cases.
- The tricuspid "dimple" represented the membranous atrioventricular septum and was not related to the right ventricle.
- Most interatrial communications (85%) were nonobstructive; however, obstructive communications (15%) were identified.
- Right atrial hypertrophy was most pronounced in hearts with restrictive interatrial communications and those that had undergone a Fontan operation.
- Left juxtaposition of the atrial appendages was present in 11% of patients, a finding with potential relevance for the Fontan procedure.
Conclusions:
- Atrial morphology in tricuspid atresia exhibits significant variations, including prominent eustachian valves and diverse interatrial communications.
- The degree of right atrial hypertrophy correlates with the severity of interatrial communication restriction and prior Fontan operation.
- Left atrial appendage juxtaposition is a notable finding that may impact surgical planning for the Fontan operation.