Tricuspid valve detachment for transatrial closure of ventricular septal defects

Surgical strategies and novel alternatives for the closure of ventricular septal defects

A variety of therapies are available to close ventricular septal defects (VSDs). These include surgical closure on bypass, percutaneous device closure, as well as perventricular hybrid closure. Due to the incidence of heart block (1-5%) associated with percutaneous device closure of perimembranous VSDs, surgical closure presently remains the gold standard and preferred therapy for these defects. Therapeutic options are more varied for muscular VSDs. Beyond infancy, transcatheter closure offers excellent results with low morbidity and mortality, without the need for cardiopulmonary bypass. Infants however have a higher incidence of adverse events using a percutaneous approach. Large mid-muscular VSDs in infants can be treated successfully using a hybrid approach, surgical closure on bypass or a percutaneous approach. However, VSDs located apically or anteriorly are difficult to identify surgically and for these infants, perventricular hybrid closure should be considered as the preferred therapeutic modality. However, some VSD's also can be closed percutaneously.

Temporary Tricuspid Valve Detachment for Ventricular Septal Defect Closure: Is It Worth Doing It?

<p><b>Background:</b> Tricuspid valve detachment (TVD) may improve the access for closing certain ventricular septal defects (VSDs), but it has some potential risks. We aimed to study the benefits and drawbacks of this technique.</p><p><b>Methods:</b> The midterm outcomes of all 20 patients who underwent a TVD closure for VSD were reviewed and compared with a control group of 15 patients with VSD closure without TVD.</p><p><b>Results:</b> There was no significant residual shunt in either group at the last actuarial follow-up. Tricuspid regurgitation occurred in both groups (45% in the TVD group and 27% in the control group, <i>P</i> = .48). These lesions were considered insignificant in all patients. There were no atrioventricular blocks, and all patients were in sinus rhythm. The cardiopulmonary bypass times were significantly higher in the TVD group than in the control group (91.6 � 17.2 minutes versus 68.3 � 15.7 minutes, <i>P</i> ? .01), as were the aortic cross-clamping times (50.7 � 12.1 minutes versus 35.9 � 14.4 minutes, <i>P</i> ? .01).</p><p><b>Conclusion:</b> Our results, along with results from other series, suggest that TVD can be used effectively and safely for closure of certain VSDs.</p>

The Role of Tricuspid Valve Surgery in the Late Management of Tetralogy of Fallot

While surgical repair of tetralogy of Fallot (TOF) is generally associated with good early outcomes, late complications affect long-term survival and may require reoperation. Pulmonary regurgitation (PR) and tricuspid regurgitation (TR) may increase the risk of arrhythmias, reduced cardiac function, and sudden death. Tricuspid valve function can be compromised secondarily in the setting of PR or directly as a result of injury or alteration of the valve related to the original TOF repair. This article reviews the etiologic mechanisms, pathophysiological implications, and surgical interventions for TR. Effective management following TOF repair requires consideration of TR to optimize late outcomes.

Indications for Tricuspid Valve Detachment in Closure of Ventricular Septal Defect in Children

BACKGROUND

Different techniques have been described for tricuspid valve detachment to improve visualization in ventricular septal defect repair. Our hypothesis was that preoperative echocardiographic criteria are important in deciding which patients should undergo ventricular septal defect repair by tricuspid valve detachment, and patients who undergo this procedure may have a better surgical outcome than those who fulfilled the criteria but were actually operated on with the standard surgical approach.

METHODS

Between January 2000 and December 2004 we prospectively studied 179 patients scheduled for ventricular septal defect repair and criteria for tricuspid valve detachment were established. Of these, 84 patients did not have any criteria for tricuspid valve detachment and were classified as the control group (group 1). Ninety-five patients with at least one criterion for tricuspid valve detachment were intraoperatively divided by patients who underwent tricuspid valve detachment into group 2 (n = 41), and those who did not undergo tricuspid valve detachment into group 3 (n = 53).

RESULTS

Surgical complications occurred more frequently in group 3 (26%) as opposed to group 2 (10%) and group 1 (7%). Residual ventricular septal defect and atrioventricular block occurred only in group 3. Tricuspid regurgitation occurred in 15% of group 3 versus 9.8% of group 2 and 7.1% of group 1.

CONCLUSIONS

Preoperative criteria for tricuspid valve detachment can be established before repair of ventricular septal defect. Patients who had indications for tricuspid valve detachment who actually had detachment performed during repair had fewer postoperative surgical complications as opposed to patients who fulfilled the criteria but did not undergo detachment.