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J Thorac Cardiovasc Surg 2001;121:1040-1045
© 2001 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

A case for anatomic correction in atrioventricular discordance? Effects of surgery on tricuspid valve function

From the Cardiothoracic Unit, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom.

Received for publication May 9, 2000. Revisions requested July 13, 2000; revisions received Nov 3, 2000. Accepted for publication Nov 28, 2000. Address for reprints: Marc R. de Leval, FRCS, Cardiothoracic Unit, Great Ormond Street Hospital for Children NHS Trust, Great Ormond St, London WC1N 3JH, United Kingdom (E-mail: marc.deleval{at}gosh-tr.nthames.nhs.uk).

Objective: To assess tricuspid valve function in atrioventricular discordance after palliative procedures (pulmonary artery banding and Blalock-Taussig shunt) and corrective procedures (anatomic and physiologic repair).
Methods: Tricuspid valve dysfunction was assessed by transthoracic echocardiography and graded as no regurgitation (0), mild (1), moderate (2), and severe (3) before and after palliative and corrective procedures performed in 97 patients with atrioventricular discordance between 1988 and 1999. Thirty-two percent had an isolated ventricular septal defect, 43% had a ventricular septal defect and pulmonary stenosis, and 16% had pulmonary stenosis. Twenty-six patients underwent pulmonary artery banding and 28 had a Blalock-Taussig shunt. Seventy patients underwent physiologic and 19 underwent anatomic repair. Six patients underwent one-ventricle repair.
Results: After pulmonary artery banding, the tricuspid regurgitation score decreased from 1.7 ± 0.8 to 0.9 ± 0.6 (P < .001). In patients who underwent a Blalock-Taussig shunt, the tricuspid regurgitation score increased from 0.7 ± 0.5 preoperatively to 1.4 ± 0.6 postoperatively (P < .001). After physiologic repair, there was no significant change in the tricuspid regurgitation score; however, 7 patients required additional repair or replacement. The regurgitation score was significantly reduced from 1.5 ± 0.8 to 0.4 ± 0.5 (P < .001) after anatomic repair. The operative mortality in patients who underwent physiologic repair was 7% as compared with 0% in the anatomic repair group (P = .59). The median follow-up was 3.2 years.
Conclusions: Right ventricular volume loading (shunt) worsens tricuspid regurgitation, whereas volume reduction (banding) or left-to-right septal shift (anatomic repair) has beneficial effects. We have not observed a significant change in the tricuspid regurgitation score after physiologic repair. Anatomic repair can be performed in selected patients with atrioventricular discordance and provides superior functional results.

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