Right heart growth after the Bjork connection in tricuspid atresia

Atrioventricular (Bjork) connection used for the correction of tricuspid atresia has become of little more than historical interest. However, the optimal form of management of patients undergoing this repair still requires continued assessment of the long-term outcome. We review our experience with valveless atrioventricular connection focusing on the morphological changes seen in the heart chambers.

Between October 1978 and March 1986, seven patients with tricuspid atresia having concordant ventriculoarterial connection underwent atrioventricular connection. Configuration of the surgical connection included Dacron extracardiac conduit without valve insertion. End-diastolic volumes were calculated in the respective heart chambers. A group of patients undergoing atriopulmonary connection was used as control subjects.

The diminutive right ventricle showed conspicuous growth at 1.1 +/- 1.1 years after the initial repair, with the end-diastolic volume index increasing from 25.0 +/- 8.7% of normal value at a preoperative state to 80.4 +/- 31.1% of normal value postoperatively. Further operation was done in three patients because of the obstructive atrioventricular pathway. At reoperation, reconstruction of the connection with an addition of either atriopulmonary or cavopulmonary anastomosis afforded clinical improvement in our series.

This study suggests that volume load resulting from the widely patent atrioventricular connection combined with backward regurgitation affects the development of young heart muscle of the right ventricle. The optimal choice of surgical strategy should be made at reintervention through recognition of the particular postsurgical anatomy.