Related Experiment Videos
[Tricuspid valve closure for pulmonary atresia with intact ventricular septum]
K Shiraga1, K Yamazaki, K Kohchi
1Department of Cardiovascular Surgery, Kurashiki Central Hospital, Japan.
Insights
Tricuspid valve closure in children with pulmonary atresia improved left ventricle function, aiding Fontan procedure preparation. This intervention demonstrated benefits for managing complex congenital heart disease.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Cardiac Surgery
Context:
- Pulmonary atresia with intact ventricular septum presents complex challenges, particularly with major right ventricle-coronary communications and hypoplastic right ventricles.
- Management strategies for these complex cases require careful consideration of ventricular function and surgical pathways.
- Tricuspid valve closure is explored as a potential intervention in select pediatric cardiac cases.
Purpose:
- To evaluate the impact of tricuspid valve closure on left ventricle function in children with pulmonary atresia and intact ventricular septum.
- To assess the role of tricuspid valve closure as a preparatory step for the Fontan procedure.
- To investigate specific indicators of left ventricle function, including LVEF, LVEDVI, LVEDP, and mitral regurgitation.
Summary:
- Four children with pulmonary atresia, intact ventricular septum, major right ventricle-coronary communications, and severely hypoplastic right ventricles underwent tricuspid valve closure.
- All patients survived the tricuspid valve closure; three subsequently underwent the Fontan procedure.
- Postoperative assessment revealed preserved left ventricle function in survivors, with improvements in LVEF, LVEDVI, LVEDP, and mitral regurgitation, suggesting benefits for Fontan preparation.
Impact:
- Tricuspid valve closure appears to be a beneficial intervention for preserving left ventricle function in pediatric patients with complex congenital heart disease.
- This procedure may serve as a valuable preparatory step for the Fontan procedure, potentially improving outcomes.
- Findings highlight the importance of monitoring myocardial ischemia and coronary artery status in these high-risk patients.
Abstract:
Tricuspid valve closure was performed on four children who had pulmonary atresia with intact ventricular septum. All of them had major right ventricle-coronary communications and severely hypoplastic right ventricle under 30% of normal right ventricle volume. Their coronary circulations were not right ventricle dependent. All of four patients survived tricuspid valve closure. Three children were performed Fontan procedure. One child, with severe change in her coronary arteries preoperatively, once improved her myocardial ischemia in early stage after tricuspid valve closure, however, the myocardial ischemia progrssed in one year later and died suddenly three years and five months after tricuspid valve closure. Three survivors remained good condition in their left ventricle function postoperatively. In this study, we investigated changes in LVEF, LVEDVI, LVEDP and mitral regurgitation as indicators of left ventricle functions through tricuspid valve closure. It revealed that tricuspid valve closure had advantages in preservation of left ventricle function and in preparation for Fontan procedure consequently.