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Biventricular repair of lesions with straddling tricuspid valves using techniques of cordal translocation and realignment

Published online by Cambridge University Press:  19 August 2008

V. Mohan Reddy ,
John R. Liddicoat ,
Doff B. McElhinney ,
Michael M. Brook ,
Jacques A.M. van Son  and
Frank L. Hanley
V. Mohan Reddy*
Affiliation:
Division of Cardiothoracic Surgery, University of California, San Francisco, CA, USA
John R. Liddicoat
Affiliation:
Division of Cardiothoracic Surgery, University of California, San Francisco, CA, USA
Doff B. McElhinney
Affiliation:
Division of Cardiothoracic Surgery, University of California, San Francisco, CA, USA
Michael M. Brook
Affiliation:
Division of Pediatric Cardiology,University of CaliforniaSan Francisco, CA, USA
Jacques A.M. van Son
Affiliation:
Division of Cardiothoracic Surgery, University of California, San Francisco, CA, USA
Frank L. Hanley
Affiliation:
Division of Cardiothoracic Surgery, University of California, San Francisco, CA, USA
*
V. Mohan Reddy, M.D., Division of Cardiothoracic Surgery, University of California, San Francisco, 505 Parnassus Avenue, M593, San Francisco, CA 94143-0118. Tel: 415-476-3501; Fax: 415-476-9678
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Abstract

Surgical Management of straddling tricuspid valve and associated defects is a complex problem. Between August 1992 and August 1995, 5 patients with major straddling of the tricuspid valve underwent a complete or partial biventricular repair. All patients had either an inlet ventricular septal defect (n=4) or a ventricular septal defect with an inlet component (n=1), Co-existing cardiac lesions included hypoplasia of the right ventricle (n=3), discordant ventriculoarterial connections (n=1), tetralogy of Fallot (n=1), and multiple muscular vetricular septal defects (n=2). At the time of presentation to our institution, two of these patients had previously been palliated in preparation for a Fontan procedure, having undergone construction of a bidirectional superior cavopulmonary shunt. One patient was referred specifically for a Fontan procedure. The tricuspid valve was repaired by transecting all of the straddling cords and reattaching them in the right ventricle or onto the right side of the patch used to close the ventricular septal defect. Associated procedures included closure of the septum in all patients, an arterial switch procedure in one, repair of tetralogy of Fallot in one, and construction of a bidirectional superior cavopulmonary shunt in one. There has been no early or late mortality. Complete heart block requiring insertion of a pacemaker occurred after surgery in three patients. At a median follow-up of 32 months, functional integrity of the tricuspid valve is well maintained, with only one patient having moderate tricuspid regurgitation. None of the patients are receiving any cardiac medication.

Keywords

One-and-a-half ventricle repaircomplete heart blockstraddling atrioventricular valve
Type
Original Articles
Information
Cardiology in the Young , Volume 7 , Issue 2 , April 1997 , pp. 147 - 152
Copyright
Copyright © Cambridge University Press 1997

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References

1.Milo, S, Ho, SY, Macartney, FJ, Wilkinson, JL, Becker, AE, Wenink, ACG, Gittenberger-deGroot, AC, Anderson, RH. Straddling and overriding atrioventicular valves: Morphology and classification. Am J Cardiol 1979; 44: 1122–1134.CrossRefGoogle Scholar
2.Kirklin, JW, Barratt-Boyes, BG. Cardiac Surgery. Churchill Livingston, New York, 1993, pp 811–817.Google ScholarPubMed
3.Wenink, ACG, Gittenberger-de Groot, AC. Straddling mitral and tricuspid valves: Morphologic differences and develop mental backgrounds. Am J Cardiol 1982; 49: 1959–1971.CrossRefGoogle Scholar
4.de Vivie, R, Van Praagh, S, Bein, G, Eigster, G, Vogt, J, Van Praagh, R. Transposition of the great arteries with straddling tricuspid valve: Report of two rare cases with acquired subaortic stenosis after main pulmonary artery banding. J Thorac cardiovasc Surg 1989; 98: 205–213.CrossRefGoogle ScholarPubMed
5.Kirklin, JW, Anderson, RH, Pacifico, AD, Kirklin, JK, Bargeron, LM. Surgery for hearts with straddling and overriding atrioventricular valves. In: Baue, AE, Geha, AS, Hammond, GL, Laks, H, Naunheim, KS (eds). Glenn's Thoracic and Cardiovascular Surgery. Appleton & Lange, Norwalk, 1991, pp 1069–1078.Google Scholar
6.Danielson, GK, Tabry, IF, Fulton, RE, Hagler, DJ, Ritter, DG. Successful repair of straddlingt atrioventricular valve by technique used for septation of univentricular heart. Ann Thorac Surg 1979; 28: 554–560.CrossRefGoogle ScholarPubMed
7.Pacifico, AD, Soto, B, Bargeron, LM. Surgical treatmemt of straddling tricuspid valves. Circulation. 1979; 60: 655–664.CrossRefGoogle Scholar
8.Tabry, IF, McGoon, DC, Danielson, GK, Wallace, RB, Tajik, AJ, Seward, JB. Surgical management of straddling atrioventricular valve. J Thorac Cardiovasc Surg 1979; 77: 191–201.CrossRefGoogle ScholarPubMed
9.Serraf, A, Nakamura, T, Lacour-Gayet, F, Piot, D, Bruniaux, J, Touchot, A, Sousa-Uva, M, Houyel, L, Planché, C. Surgical approaches for double-outlet right ventricle or transposition of the great arteries associated with straddling atrioventircular valves. J Thorac Cardiovasc Surg 1996; 111: 527–535.CrossRefGoogle ScholarPubMed
10.Wilcox, BR, Anderson, RH. Surgical Anatomy of the Heart, 2nd Edition. Gower Medical Publishing, London, 1992.Google Scholar
11.Hoyer, MH, Zuberbuhler, JR, Anderson, RH, del Nido, P. Morphology of ventricular septal defects in complete trasposition. J Thorac Cardiovasc Surg 1992; 104: 1203–1211.CrossRefGoogle Scholar
12.Driscoll, DJ, Offord, KP, Feldt, RH, Schaff, HV, Puga, FJ, Danielson, GK. Five-to fifteen-year follow-up after Fontan operation. Circulation 1992; 85: 469–496.CrossRefGoogle ScholarPubMed
13.Fontan, F, Kirklin, JW, Fernandez, G, Costa, F, Naftel, DC, Tritto, F, Blackstone, EH. Outcome after a “perfect” Fontan operation. Circulation 1990; 81: 1520–1536.CrossRefGoogle ScholarPubMed