Outcome following tricuspid valve detachment for ventricular septal defects closure

Division of Pediatric Cardiothoracic Surgery, The Cardiac Center at The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, 19104, Philadelphia, PA, USA.
European Journal of Cardio-Thoracic Surgery (Impact Factor: 3.3). 04/2001; 19(3):279-82. DOI: 10.1016/S1010-7940(01)00577-2
Source: PubMed


Detachment of the septal leaflet of the tricuspid valve from the annulus (TVD) has been used to improve visualization of ventricular septal defects (VSDs), but may be associated with increased operative time, heart block, and the development of tricuspid regurgitation (TR).
Patients undergoing VSD closure between 1/1/96 and 31/12/99 were retrospectively reviewed. Follow-up was obtained from the patients' cardiologists.
Transatrial VSD closure was performed in 172 patients with TVD in 36 (21%) at the surgeon's discretion. The leaflet incision was repaired with a separate suture (22) or with the VSD patch suture (14). Additional procedures including arch augmentation, closure of atrial septal defects, and closure of additional VSDs were performed in 93 (68%) non-TVD patients and 20 (56%) TVD patients. The median age was 6.2 months (range 1 day to 46 years) and the median weight was 5.9 kg (range 1.5-71.5 kg). Cardiopulmonary bypass (CPB) time was 64+/-24 min and cross-clamp time was 34+/-16 min. One hospital death occurred in an infant with tracheal stenosis. No child in either group developed complete heart block. The median duration of postoperative stay was 4 days (range 2-49 days). There were no differences in CPB time, cross-clamp time or postoperative stay between the TVD and non-TVD groups (P>0.1 for all). At a mean follow-up of 17+/-15 months, there have been two late deaths unrelated to cardiac disease. No child in the TVD group required reoperation for residual VSD, compared to three in the non-TVD group. No child in the TVD group has greater than mild TR, but six in the non-TVD group have greater than mild TR. No child in either group has undergone reoperation for TR.
TVD is a safe, effective technique to improve visualization of VSD and is not associated with heart block, increased operative time, or TR. TVD may result in improved preservation of tricuspid valve architecture and decrease the incidence of significant postoperative TR.

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    ABSTRACT: The purpose of this retrospective study was to assess long-term outcome of children after surgical closure of a ventricular septal defect (VSD). Between January 1992 and December 2001 a consecutive series of 188 patients (100 females) were operated for closure of a VSD. Temporary tricuspid valve detachment (TVD) was applied in 46 patients (24%) to enhance exposure of the defect using transatrial approach. Pre-operative baseline characteristics showed that the detached group was younger (0.79+/-1.8 vs 2.1+/-3.5 years, p=0.002) and had a lower weight (6.5+/-6.4 vs 10.0+/-11.0 kg, p=0.009). There was no difference in cross-clamp time (temporary TVD 36.2+/-11.3 vs non-temporary TVD 33.6+/-13.1 min, p=0.228). Postoperative echocardiography showed that 67 patients (36%) had trivial/minimal regurgitation, 10 patients (22%) from the temporary TVD group vs 57 patients (40%) from the non-detached group (p=0.02). There was no tricuspid stenosis. Hospital mortality comprised two patients (1%). One patient died due to a pulmonary hypertensive crisis and one in relation to an acute patch dehiscence for which an emergency reoperation was necessary. At first postoperative echocardiography no shunting was detected in 113 patients, trivial shunting in 73 and significant shunting in none. Multivariate logistic regression analysis revealed that weight at operation was a predictive factor for the occurrence of residual shunting (OR 0.95, C.I. 0.91-0.99). One patient with conduction disturbances needed a permanent DDD-pacemaker. Three patients were lost to follow-up. Mean follow-up time was 2.6 years (range 0.1-9.4). During follow-up no reoperations were necessary for closing a residual VSD. One patient died 7 months postoperative due to a bronchopneumonia. During follow-up in 37 (51%) of the 73 patients the trivial shunting disappeared spontaneously at a median time of 3.9 years. According to actuarial analysis all trivial shunting had disappeared at 8.4 years. Trivial residual shunting disappeared spontaneously at a median follow-up time of 3.9 years. During follow-up no patient needed to be reoperated for residual VSD. TVD proved to be a safe method to enhance the exposure of a VSD.
    European Journal of Cardio-Thoracic Surgery 11/2003; 24(4):511-5. DOI:10.1016/S1010-7940(03)00430-5 · 3.30 Impact Factor

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    ABSTRACT: BackgroundDetachment of the Tricuspid Valve Leaflet (TVD) has been described for better access to repair Perimembranous Ventricular Septal Defects (pVSD). The present report is our early experience with which has been found to be safe and easy with reproducible results. MethodsFrom August 2007 to December 2008, 18 patients underwent closure of pVSD through a right atrial approach with TVD at our institute. The preoperative profile, operative procedure, echocardiographic findings, postoperative course and stay, and follow up data were sequentially recorded. ResultsThe median age was 14 years. There was no residual VSD, no progression of mild Tricuspid Regurgitation (TR) and no Aortic Regurgitation (AR). Post operative temporary rhythm disturbance occured in 1 case that reverted back to sinus rhythm in 72 hours. 1 case was re-explored for mediastinal bleeding. Mean post operative hospital stay was 8±2 days with no significant adverse event. In follow up period, there were no significant complaints. ConclusionsThis study suggests that TVD is a safe, effective and technically easy method in the armamentarium of cardiac surgeon that improves exposure of posterosuperior boundary of pVSD, decreases undue traction over tricuspid valve leaflets and does not adversely affect tricuspid valve competence and results in decreased incidence of residual VSD, TR and conduction disturbances.
    Indian Journal of Thoracic and Cardiovascular Surgery 01/2009; 25(2):49-51. DOI:10.1007/s12055-009-0032-x
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