Success of Tricuspid Valve Detachment for Ventricular Septal Defect Closure: An Assessment of Midterm Tricuspid Valve Function

Abstract

Introduction: Ventricular septal defect VSD is the most common congenital heart anomaly. In surgical treatment, the transatrial approach is frequently utilized because of causing less right bundle block and ventricular scarring. However, some VSDs are obscured by the chordae tendineae or a pouch formation of the septal leaflet; therefore, alternative techniques are required. In such cases, tricuspid valve detachment TVD provides a complete visualization and ease to access to ventricular septal defects. In this study, we evaluated the results of the patients of whom we performed TVD.Patient and Method: Our study includes 50 patients who underwent TVD during the procedure with the diagnosis of perimembranous VSD. Patients were examined by transthoracic echocardiography TTE before and after operation and the valvular functions are evaluated. All patients were kept in follow up for 3 months after discharge.Results: The mean age of the patients was 27.56±34.81 months. At the end of the study, all patients were in New York Heart Association class I. There was no residual shunt through VSD. Except 4 patients with mild tricuspid regurgation TR , the TTE has not revealed any TR in majority of patients.Conclusion: We suggest that, in appropriate patients, VSD closure can be performed safely with a TVD application thru an incision of the septal leaflet of the tricuspid valve without any adverse effect on function or growth at of the valve at midterm follow-up

Keywords

• Ventricular septal defect,tricuspid valve detachment,congenital heart surgery

References

1. Hoffman JI, Kaplan S. The incidence of congenital heart disease. J Am Coll Cardiol 2002;39:1890–1900. [CrossRef]
2. Danford DA, Martin AB, Fletcher SE, et al. Children with heart murmurs: can ventricular septal defect be diagnosed reliably without an echocardiogram? J Am Coll Cardiol 1997;30:243–246. [CrossRef]
3. Gabriel HM, Heger M, Innerhofer P, et al. Long-term outcome of patients with ventricular septal defect considered not to require surgical closure during childhood. J Am Coll Cardiol 2002;39:1066– 1071. [CrossRef]
4. Hudspeth AS, Cordell AR, Meredith JH, Johnston FR. An improved transatrial approach to the closure of ventricular septal defects. J Thorac Cardiovasc Surg 1962;43:157–165.
5. Sasson L, Katz MG, Ezri T, et al. Indications for tricuspid valve detachment in closure of ventricular septal defect in children. Ann Thorac Surg 2006;82:958–963. [CrossRef]
6. Jacobs JP, Mavroudis C, Jacobs ML, et al. Lessons learned from the data analysis of the second harvest (1998–2001) of the Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database. Eur J Cardiothorac Surg 2004;26:18–37. [CrossRef]
7. Lin YJ, Chang JP, Chien SJ, Liang CD, Huang CF, Kao CL. Novel method for evaluating tricuspid valve function after tricuspid valve detachment in the repair of perimembranous ventricular septal defects. Tex Heart Inst J 2012;39:806–808.
8. Maile S, Kadner A, Pretre R. Detachment of the anterior leaflet of the tricuspid valve to expose perimembranous ventricular septal defects. Ann Thorac Surg 2003;75:944–946. [CrossRef]

9. Russell HM, Forsberg K, Backer CL, Wurlitzer KC, Kaushal S, Mavroudis C. Outcomes of radial incision of the tricuspid valve for ventricular septal defect closure. Ann Thorac Surg 2011;92:685–690. [CrossRef]
10. Gaynor JW, O’Brien JE Jr, Rychik J, Sanchez GR, DeCampli WM, Spray TL. Outcome following tricuspid valve detachment for ventricular septal defects closure. Eur J Cardiothorac Surg 2001;19:279–282. [CrossRef]
11. Fraser CD, Zhou X, Palepu S, et al. Tricuspid Valve Detachment in Ventricular Septal Defect Closure Does Not Impact Valve Function. Ann Thorac Surg 2018;106:145–150. [CrossRef]
12. Weymann A, Georgiev S, Vogelsang C, et al. Temporary tricuspid valve detachment for ventricular septal defect closure: Is it worth doing it? Heart Surg Forum 2013;16:99. [CrossRef]
13. Zhao J, Li J, Wei X, Zhao B, Sun W. Tricuspid valve detachment in closure of congenital ventricular septal defect. Tex Heart Inst J 2003;30:38–41.
14. Pourmoghadam KK, Boron A, Ruzmetov M, et al. Septal Leaflet versus Chordal Detachment in Closure of Hard-To-Expose Ventricular Septal Defects. Ann Thorac Surg 2018;106:814–821. [CrossRef]
15. Bang JH, Park CS, Park JJ, et al. Detachment of the tricuspid valve for ventricular septal defect closure in infants younger than 3 months. J Thorac Cardiovasc Surg 2016;152:491–496. [CrossRef]
16. Lucchese G, Rossetti L, Faggian G, Luciani GB. Long-term follow-up study of temporary tricuspid valve detachment as approach to VSD repair without consequent tricuspid dysfunction. Tex Heart Inst J 2016;43:392–396. [CrossRef]
17. Andersen HO, de Leval MR, Tsang VT, Elliott MJ, Anderson RH, Cook AC. Is complete heart block after surgical closure of ventricular septum defects still an issue? Ann Thorac Surg 2006;82:948–956. [CrossRef]
18. Bol-Raap G, Weerheim J, Kappetein AP, Witsenburg M, Bogers AJ. Follow-up after surgical closure of congenital ventricular septal defect. Eur J Cardiothorac Surg 2003;24:511–515.[CrossRef]