Original article
Tricuspid valve abnormalities in patients with atrioventricular discordance: Surgical implications

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Abstract

From 1975 to 1990,90 patients (age, 6 months to 30 years; mean, 9.1 years) underwent operation for defects associated with atrioventricular discordance. Twenty-one had an anatomically abnormal tricuspid (systemic) atrioventricular valve (SAVV) of the following types: Ebstein, 11; straddling, 6; and dysplastic, 4. Sixteen valves were regurgitant: régurgitation was trivial to mild in nine and moderate to severe in seven. Two patients underwent a successful Fontan-type operation. None of the 5 patients with a competent SAVV underwent valve repair or replacement; 1 of these patients died. A ventricular septal defect was closed in 14 and an extracardiac valved conduit was placed in 7. Sixteen had a regurgitant valve: it was replaced in 10 and repaired in 2 (early mortality. 25%). All 4 patients who did not undergo repair or replacement of their regurgitant SAVV died. Two patients died late after repeat replacement. Four other reoperations (closure of a residual ventricular septal defect, SAVV replacement, left ventricle-to-pulmonary artery conduit replacement, and a redo Fontan procedure) were successful. Two patients are lost to follow-up, and 9 have been followed up for from 27 to 156 months (median, 117 months). All were well when last seen. We suggest that in abnormal régurgitant SAVV should be replaced. Alternatively, a “double-switch” procedure that leaves the tricuspid valve in the pulmonary circulation may be used.

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Cited by (24)

  • Is the Morphologic Mitral Valve in Discordant Atrioventricular Connections Always Normal?

    2008, Annals of Thoracic Surgery
    Citation Excerpt :

    As for the pattern of ventriculo-arterial connection, finding of an unusual mitral valve was less common in hearts with pulmonary atresia with the aorta arising from the right ventricle, compared with those with a double outlet or discordant ventriculo-arterial connection, although no particular morphologic reason was found. Structural abnormalities in the morphologic tricuspid valve have been well-documented in hearts with discordant atrioventricular connections [7–9]. In contrast, little attention has been paid to the morphology of the mitral valve in this setting [10].

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