Angiocardiographic evaluation of right ventricular size and morphology in tricuspid atresia

The potential for right ventricular growth and physiological repair in tricuspid atresia may influence the type of Fontan procedure. To evaluate preoperative right ventricular assessment, we compared the right ventricular size and morphology determined by selective right ventricular catheterization with axial left ventricular angiography. In seven consecutive patients with tricuspid atresia and ventriculo-arterial concordance, the right ventricular volume was 12.8 +/- 9.4 cc, with a predicted normal volume (based on body surface area) of 31 +/- 16 cc, 43% (range 24-78%) of normal. Right ventricular injection outlined a right ventricular area twice that visualized from an axial left ventricular injection (33.2 vs. 16.5 cm). All patients had a well developed but small trabecular portion of the right ventricle, often unopacified with left ventricular injection. Subinfundibular narrowing adjacent to the ventricular septal defect was invariably present, creating, in effect, a two-chambered right ventricle. Selective right ventriculography demonstrates the unique morphology of the right ventricle in patients with tricuspid atresia not visualized by axial left ventriculography.