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J Thorac Cardiovasc Surg 1996;111:342-347
© 1996 Mosby, Inc.

SURGERY FOR CONGENITAL HEART DISEASE

REGRESSION OF TRICUSPID REGURGITATION AFTER TWO-STAGE ARTERIAL SWITCH OPERATION FOR FAILING SYSTEMIC VENTRICLE AFTER ATRIAL INVERSION OPERATION

San Francisco, Calif.

From the Divisions of Cardiothoracic Surgery and Pediatric Cardiology, UCSF, San Francisco, Calif.

Received for publication Feb. 13, 1995. Accepted for publication April 13, 1995 Address for reprints: F. L. Hanley, MD, Division of Cardiothoracic Surgery, UCSF, 505 Parnassus Ave., San Francisco, CA 94143-0118.

Abstract

The cases of five patients with previous Senning (n = 4) or Mustard (n = 1) operations and failing systemic ventricles in whom banding of the pulmonary artery was performed as an interim step toward an arterial switch procedure are reported. The rise in the ratio of left to right mean systolic ventricular pressure, from 0.35 before operation to 0.90 during operation and 0.80 on the first postoperative day, caused a shift of the ventricular septum from a leftward to a midline or nearly midline position. This shift was associated with a reduction of tricuspid regurgitation. At a median interval of 5.1 months after pulmonary artery banding, the mean left ventricular posterior wall thickness had increased to 8.2 mm, versus 5 mm before operation, and the mean left ventricular myocardial mass index had increased to 90 gm/m², versus 55.6 gm/m²before operation. After the arterial switch operation, which was performed in four patients, the tricuspid regurgitation decreased to a trivial amount (n = 1) or disappeared completely (n = 3). (J THORACCARDIOVASCSURG1996;111:342-7)

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