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["Straddling" tricuspid valve across an isolated ventricular septal defect. Apropos of 4 cases]
Insights
This study reports on four children with ventricular septal defects and straddling tricuspid valve. Surgical repair of these complex congenital heart defects was successful in all patients, with no complications.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Cardiac Surgery
Background:
- Ventricular septal defects (VSD) and straddling tricuspid valve are complex congenital heart anomalies.
- Diagnosis and management require specialized understanding of cardiac anatomy.
Observation:
- Four pediatric cases (10 months–3 years) with isolated VSD and straddling tricuspid valve were analyzed.
- Two cases were diagnosed intraoperatively; 2D echocardiography aided diagnosis in others.
- Surgical repair involved VSD closure, preserving tricuspid valve function.
Findings:
- All three surgically treated patients survived without atrioventricular block or tricuspid incompetence.
- VSD types included perimembranous and muscular, with varying degrees of tricuspid valve straddling.
- One patient with a well-tolerated lesion and mitral regurgitation awaits surgery.
Implications:
- Straddling tricuspid valve can mimic isolated VSD, necessitating consideration in posterior VSD cases.
- Early diagnosis and appropriate surgical intervention are crucial for favorable outcomes.
- This condition highlights the importance of detailed echocardiographic assessment in pediatric cardiac evaluations.
Abstract:
Four cases of children from 10 months to 3 years of age with isolated ventricular septal defects and straddling tricuspid valve are reported. Three patients underwent surgery (mean age: 24 months). The lesion was diagnosed during operation in 2 cases. The VSD was a perimembranous defect with extension to the ventricular inlet in 2 cases, and in the other it was entirely muscular. The straddling involved all the septal leaflet of the tricuspid valve in 1 case. In two cases, there was doubling of the segment with one part crossing the VSD. The left ventricular attachment was a type B in 2 patients and type C in 1 patient. The tricuspid ring was normally situated in all patients (no overriding). In 2 patients, the diagnosis was made with the aid of complementary investigations, and, in particular, 2D echocardiography. One of these patients has not yet undergone surgery as the lesion is well tolerated and because of associated mitral regurgitation. In 3 patients, surgery consisted of repairing the ventricular septal defect, leaving the abnormal part of the tricuspid valve in the left ventricle. All patients survived; there were no cases of post-operative atrioventricular block or signs of tricuspid incompetence. With reference to these three cases, the authors review the main anatomical lesions, the diagnostic signs and different methods of treatment of this condition. Straddling tricuspid valve may present as a simple ventricular septal defect. This diagnosis should be considered in all cases of posterior ventricular septal defects.