Congenital tricuspid incompetence

Congenital tricuspid regurgitation: review and a proposed new classification

BACKGROUND AND AIM

Congenital tricuspid regurgitation is an extremely rare condition. The morphologic heterogeneity makes it difficult to derive any conclusions regarding the best strategy for management of this condition.

METHODS

We analysed the published literature on "congenital tricuspid regurgitation" using MEDLINE. In addition, the reference sections of all relevant articles were searched to identify additional cases. Studies published till June 2009 are included.

RESULTS

As far as we could establish, there were 123 cases of congenital tricuspid regurgitation. Of these, 63 were documented during surgery, 38 during autopsy, and 22 were diagnosed by echocardiography or cardiac catheterisation. The mean age was 22.57 years, with a standard deviation of 23.42 years, and the age ranged from 1 day to 80 years, with a median of 16 years. There was a male predominance, with a male-to-female ratio of approximately 3:2.

CONCLUSION

Congenital tricuspid regurgitation is an uncommon clinical entity with wide anatomical variations. The severity of disease dictates the presentation in infancy, childhood, or adulthood. Tricuspid valve repair is the ideal treatment whenever feasible, especially in children. We propose a new classification for congenital tricuspid regurgitation, which not only includes the anatomical variations, but can also help the surgeon in deciding on the best strategy for management.

Dysplasia of the atrioventricular valves associated with conduction system anomalies

Clinical, vectorcardiographic, and echocardiographic data from two siblings with atrial septal defects and dysplasia of the mitral and tricuspid valves are reported. Vectorcardiograms showed that both siblings had abnormal ventricular activation with initial electrical forces directed posteriorly. One sibling died after surgery, and necropsy showed incomplete differentiation of the leaflets and tensor apparatus producing anomalies resembling "mitral arcade." Serial histological examination of the conducting tissue showed that the atrioventricular node was located on the left side of the atrial septum, that the central fibrous body and the membranous septum were hypoplastic, and that an accessory nodoventricular pathway originating in the compact node joined the left side of the ventricular septum. This accessory pathway was probably the cause of the unusual ventricular activation. Dysplasia of the mitral and tricuspid valves together with hypoplasia of the central fibrous body and the presence of accessory pathways are probably part of a malformative complex caused by incomplete differentiation of both the cardiac atrioventricular valves and the junctional area.

Acquired tricuspid incompetence in children: pitfalls in the clinical diagnosis of its aetiology

Pitfalls in the clinical diagnosis of the aetiology of acquired tricuspid incompetence in children were exemplified in five patients. In three of them acute staphylococcal endocarditis, the cause of the valve defect, was obscured during life by co-existing sickle cell haemoglobinopathy, acute leukaemia and rheumatic mitral valvulitis, respectively. The fourth and fifth patients had clinical features suggestive of right ventricular endomyocardial fibrosis but necropsy revealed that the tricuspid incompetence was caused by dilated cardiomyopathy and constrictive pericarditis respectively. This series illustrates the need to suspect bacterial endocarditis if a child presents with signs of infection and valvular incompetence, and also dispels the widespread belief that pericardial constriction does not cause tricuspid incompetence.

Massive congenital tricuspid insufficiency in the newborn

Three cases of massive congenital tricuspid incompetence in the newborn are reported and discussed from diagnostic, pathologic and etiologic points of view. The diagnosis is important as cases have been reported with spontaneous resolution.

Congenital tricuspid insufficiency

This is a case report of a 16-year-old male with moderate mitral disease, probably rheumatic, and with severe tricuspid insufficiency, which at surgery appeared to be a congenital malformation of the tricuspid valve (absence of the anterior leaflet). A tricuspid heterograft was successfully inserted. The symptoms of congenital tricuspid insufficiency are discussed, and this entity is differentiated from other causes of tricuspid insufficiency.

Case report of congenital tricuspid insufficiency

Congenital tricuspid insufficiency is a rare disease secondary to malformations of the tricuspid valve and their chordae tendinae. Diagnosis is difficult but worthwhile, since surgery can be performed. We report one case repaired by surgery.

Congenital tricuspid insufficiency. Definition and review

Simple congenital tricuspid insufficiency (CTI) has, up to now, been loosely included with the larger Ebstein's anomaly (EA) group. Certain pathologic and clinical features of CTI deserve definition and a place apart from EA. A review of the literature has produced 20 clinical cases for analysis to which we add two cases successfully treated surgically. The high mortality in the neonatal age group (14 of 14) continues to be a formidable challenge, but the older survivors (2 of 8) would appear to have better prospects, based on our limited experience.

Right-to-left interatrial shunting with normal right ventricular pressure. A puzzling haemodynamic picture associated with some rare congenital malformations of the right ventricle and tricuspid valve

Haemodynamic and angiographic findings are described in 5 cases with rare anomalies of the right ventricle and the second there was isolated congenital 'absence' of the tricuspid valve. The remaining 3 cases all had isolated congenital hypoplasia of the right ventricle; in 2 of these 3 cases closure of the atrial septal defect was successful in abolishing cyanosis and symptoms,while the third is awaiting surgical correction.

Congenital heart disease in Nigeria. Clinical and necropsy study of 260 cases

The present study of 260 combined necropsy and clinical cases of congenital heart defect has revealed that the various types of defects occur in the same proportions in Africans as in non-Africans. The frequency of associated noncardiac malformations, the cause of death, and sex distribution are similar to what has been described in non-Africans. Of the possible aetiological factors, there was evidence of a causal relation between maternal rubella infection and persistent ductus arteriosus. There was, however, no such evidence in respect of abnormal haemoglobins, maternal age, and birth rank.

Calcific tricuspid incompetence in childhood

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