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Tricuspid valve closure in pulmonary atresia and important RV-to-coronary artery connections

J D Waldman1, R B Karp, J J Lamberti

  • 1Section of Pediatric Cardiology, University of Chicago, Illinois.

The Annals of Thoracic Surgery
|April 1, 1995
PubMed

Insights

Surgical closure of the tricuspid valve can improve survival for children with pulmonary atresia, intact ventricular septum, and right ventricle-to-coronary artery connections. Early intervention is recommended to prevent myocardial ischemia.

Area of Science:

  • Pediatric Cardiology
  • Congenital Heart Disease
  • Cardiac Surgery

Background:

  • Children with pulmonary atresia, intact ventricular septum, and right ventricle-to-coronary artery connections face high mortality.
  • Myocardial ischemia occurs due to abnormal blood flow in systole and diastole, compromising heart function.

Purpose of the Study:

  • To evaluate the efficacy of tricuspid valve closure in managing this complex congenital heart defect.
  • To assess the impact of tricuspid valve closure on survival and myocardial ischemia.

Main Methods:

  • Tricuspid valve closure was performed in 10 children, with a balloon trial in 5.
  • Surgical closure of the tricuspid valve was combined with concurrent procedures.
  • Patients were monitored for survival, heart block, and electrocardiogram changes.

Main Results:

  • Seven out of 10 children survived surgical tricuspid valve closure without heart block.
  • Preoperative ischemic changes on ECGs were abolished post-operatively in 4 patients.
  • Two of three non-survivors likely had inoperable conditions due to preoperative ischemia.

Conclusions:

  • Surgical tricuspid valve closure is a viable option for children with pulmonary atresia, intact ventricular septum, and RV-coronary artery connections.
  • Early surgical intervention within the first year of life is recommended.
  • These patients should be managed similarly to those with tricuspid atresia post-operatively.

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