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Updated: Mar 13, 2026
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Long-Term Follow-Up Study of Temporary Tricuspid Valve Detachment as Approach to VSD Repair without Consequent
Insights
Temporary tricuspid valve detachment offers a clear view for congenital ventricular septal defect (VSD) repair. This method shows no significant long-term impact on tricuspid valve function in pediatric patients.
Area of Science:
- Pediatric Cardiology
- Cardiac Surgery
- Congenital Heart Disease
Background:
- Temporary tricuspid valve detachment is used to improve surgical visualization of congenital ventricular septal defects (VSDs).
- The long-term impact of this technique on tricuspid valve function remains a subject of debate.
Purpose of the Study:
- To evaluate the long-term effects of temporary tricuspid valve detachment on tricuspid valve function in children undergoing VSD repair.
- To assess the safety and efficacy of this surgical approach.
Main Methods:
- A prospective study of 68 children undergoing transatrial closure of VSDs with temporary tricuspid valve detachment.
- Clinical and echocardiographic monitoring for a median follow-up of 5.9 years.
- Assessment of tricuspid regurgitation, VSD closure, and overall patient status.
Main Results:
- No in-hospital or late deaths were observed.
- The majority of patients (91%) had trivial or mild tricuspid regurgitation postoperatively, with stable grades.
- No tricuspid stenosis was documented, and all patients were in New York Heart Association class I at follow-up.
Conclusions:
- Temporary tricuspid valve detachment is a safe and effective method for visualizing VSDs during surgery.
- The technique does not lead to substantial or lasting tricuspid valve dysfunction in pediatric patients.
- This approach facilitates complete VSD repair without compromising tricuspid valve integrity.
Abstract:
Temporary tricuspid valve detachment improves the operative view of certain congenital ventricular septal defects (VSDs), but its long-term effects on tricuspid valve function are still debated. From 2002 through 2012, we performed a prospective study of 68 children (mean age, 1.28 ± 1.01 yr) who underwent transatrial closure of VSDs following temporary tricuspid valve detachment. Sixty patients had conoventricular and 8 had mid-muscular VSDs. All were in sinus rhythm. Seventeen patients had systemic pulmonary artery pressures. Preoperative echocardiograms showed trivial-to-mild tricuspid regurgitation in 62 patients and tricuspid dysplasia with severe regurgitation in 6 patients. Patients were clinically and echocardiographically monitored at 30 postoperative days, 3 months, 6 months, every 6 months thereafter for the first 2 years, and then once a year. No in-hospital or late death was observed at the median follow-up evaluation of 5.9 years. Mean intensive care unit and hospital stays were 1.6 ± 1.1 and 7.3 ± 2.7 days, respectively. Residual small VSDs occurred in 3 patients, and temporary atrioventricular block in one. After VSD repair, 62 patients (91%) had trivial or mild tricuspid regurgitation, and 6 moderate. Five of these last had severe tricuspid regurgitation preoperatively and had undergone additional tricuspid valve repair during the procedure. The grade of residual tricuspid regurgitation remained stable postoperatively, and no tricuspid stenosis was documented. All patients were in New York Heart Association class I at follow-up. Temporary tricuspid valve detachment is a simple and useful method for a complete visualization of certain VSDs without incurring substantial tricuspid dysfunction.
