Abstract 11839: Tricuspid Valve Function in Hypoplastic Left Heart Syndrome
Purpose: Tricuspid valve regurgitation (TR) in hypoplastic left heart syndrome (HLHS) is an important factor affecting the patient's outcome. We studied clinical course of tricuspid valve function in patients with HLHS.
Patients and Method: From May 1991 to July 2010, 105 classic HLHS patients underwent initial palliative surgery. Of these, 44 cases (41.9%) who were complicated with moderate or more TR were involved in this study. Among them, 30 cases developed TR before BDG (early TR group), and 14 cases after BDG (late TR group). The results of tricuspid valve surgery and the influence of TR on cardiac function were analyzed.
Results: Twenty eight of 44 cases underwent total of 31 tricuspid valve surgery. As the first tricuspid valve surgery, valve repair was performed in 26 cases and valve replacement was performed in 2 cases. The timing of tricuspid valve surgery was at Norwood operation in 9 cases, at BDG or before TCPC in 17 cases and at TCPC in 5 cases. Three patients underwent re-operation (2 repair and 1 replacement). Overall actuarial survival was 62.0% at 3 years and all of 16 mortality cases were in early TR group. In early TR group, 12 of 20 surgical cases (60.0%) had anatomical tricuspid valve abnormalities. Freedom from recurrent TR after tricuspid valve surgery was 50.9% at 1 year and 36.0% at 5 years. The grade of TR (none/trivial vs. moderate/severe) showed an inverse correlation with right ventricular ejection fraction, and positive significant correlation with both cardiothoracic ratio and right ventricular end-diastolic diameter. After tricuspid valve surgery, cardiac dilation showed significant improvement.
Conclusion: The incidence of TR in the clinical course of HLHS was high, and the recurrence of TR after tricuspid valve surgery was frequent. Patients who developed TR in earlier stage often had anatomical tricuspid valve abnormalities and showed poor prognosis. Ventricular dysfunction with resultant ventricular dilatation seemed to be responsible for late TR.
- © 2011 by American Heart Association, Inc.