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Suspension of straddling tricuspid valve chordae into the appropriate ventricle
J A van Son1, J Hambsch, F W Mohr
1Herzzentrum, University of Leipzig, Germany.
Insights
This study presents a novel surgical technique for inlet ventricular septal defects with straddling tricuspid valve chordae. The modified approach successfully repairs the defect and restores tricuspid valve competence, avoiding complex baffle construction.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Inlet ventricular septal defects (VSDs) can present with complex anatomical variations.
- Straddling of the tricuspid valve chordae tendineae is a rare but challenging associated anomaly.
- Traditional VSD repair techniques may be complicated by these straddling chordae.
Observation:
- Two pediatric patients with inlet VSD and straddling chordae were identified.
- Chordae originated from the tricuspid valve septal leaflet and attached to the mitral valve's posteromedial papillary muscle and an accessory left ventricular papillary muscle.
- The straddling chordae were surgically excised along with portions of the papillary muscles.
Findings:
- A modified surgical technique involved excising straddling chordae and anchoring papillary muscle segments to the right ventricular septum.
- This approach resulted in successful ventricular septal defect closure and competent tricuspid valve function.
- The modified technique avoids the need for complex baffle construction in the inappropriate ventricle.
Implications:
- This innovative surgical modification offers a viable alternative for managing inlet VSDs with straddling chordae, particularly when chordae insert into mitral valve papillary muscles.
- It simplifies the surgical procedure and potentially reduces operative risks associated with traditional methods.
- This technique may improve outcomes for children with complex congenital heart defects involving tricuspid valve anomalies.
Abstract:
In 2 children with an inlet ventricular septal defect and straddling chordae tendineae of the septal leaflet of the tricuspid valve to the posteromedial papillary muscle of the mitral valve and to an accessory papillary muscle in the left ventricle, the straddling chordae were excised with a wedge of posteromedial papillary muscle and with the top segment of the accessory papillary muscle, respectively. After patch closure of the ventricular septal defect, the papillary muscle segment with its group of chordae was anchored to the right ventricular septum with resulting competence of the tricuspid valve. In contrast to the traditional repair technique, the reported modification is applicable when the straddling chordae insert into a papillary muscle of the mitral valve. In addition, various disadvantages related to the construction of a complex baffle in the inappropriate ventricle are avoided.