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Repair of the tricuspid valve in hypoplastic left heart syndrome

Published online by Cambridge University Press:  13 October 2006

Richard G. Ohye ,
Carlen A. Gomez ,
Caren S. Goldberg ,
Holly L. Graves ,
Eric J. Devaney  and
Edward L. Bove
Richard G. Ohye
Affiliation:
Division of Pediatric Cardiovascular Surgery, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
Carlen A. Gomez
Affiliation:
Division of Pediatric Cardiology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
Caren S. Goldberg
Affiliation:
Division of Pediatric Cardiology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
Holly L. Graves
Affiliation:
Division of Pediatric Cardiovascular Surgery, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
Eric J. Devaney
Affiliation:
Division of Pediatric Cardiovascular Surgery, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
Edward L. Bove
Affiliation:
Division of Pediatric Cardiovascular Surgery, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
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Abstract

The outlook for patients with hypoplastic left heart syndrome has dramatically improved over the past two decades. Universally fatal only 25 years ago, since that time outcomes for staged palliation have shown consistent improvement. Recent reports show that eight to nine patients from every ten can now leave the hospital after the Norwood procedure.1 Attrition following the Norwood procedure, nonetheless, remains significant, with from five to fifteen percent of patients dying between the first and second stages of the Norwood sequence.1–4 Only three-quarters of the patients undergoing surgery for hypoplastic left heart syndrome survive after five years, even at the centres reporting the best outcomes for the Norwood procedure.1,5 In addition to the deaths, some patients are unable to progress through the three stages of reconstruction, and may require cardiac transplantation, or have no options for further therapy. There are many causes for these mortalities and morbidities following the Norwood procedure, including elevated pulmonary vascular resistance, cardiac arrhythmias, coronary arterial insufficiency, right ventricular failure, right ventricular volume overload due to shunt-dependent physiology, and tricuspid valvar regurgitation. Many of these factors are interrelated, and may form feedback loops, which serve to propagate their adverse effects on patients with hypoplastic left heart syndrome.

Keywords

Tricuspid regurgitationtricuspid valvar repairannuloplastyNorwood procedurehemi-Fontancongential cardiac defects
Type
The Atrioventricular Valves
Information
Cardiology in the Young , Volume 16 , Supplement S3: Controversies and Challenges of the Atrioventricular Junctions and Other Challenges Facing Paediatric Cardiovascular Practitioners and their Patients , September 2006 , pp. 21 - 26
Copyright
© 2006 Cambridge University Press

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References

Tweddell JS, Hoffman GM, Mussatto KA, et al. Improved survival of patients undergoing palliation of hypoplastic left heart syndrome: Lessons learned from 115 consecutive patients. Circulation 2002; 106 (suppl I): I82–I89.Google Scholar
Azakie T, Merklinger SL, McCrindle BW, Coles JG, et al. Evolving strategies and improving outcomes of the modified Norwood procedure: A 10-year single-institution experience. Ann Thorac Surg 2001; 72: 1348–1353.Google Scholar
Ishino K, Stumper O, De Giovanni J, et al. The modified Norwood procedure for hypoplastic left heart syndrome: Early to intermediate results of 120 patients with particular reference to aortic arch repair. J Thorac Cardiovasc Surg 1999; 117: 920–930.Google Scholar
Mahle WT, Spray TL, Gaynor JW, Clark III BJ. Unexpected death after reconstructive surgery for hypoplastic left heart syndrome. Ann Thorac Surg 2001; 71: 61–65.Google Scholar
Lloyd TR. Prognosis of the hypoplastic left heart syndrome. Prog Pediatr Cardiol 1996; 5: 57–64.Google Scholar
Daubeney PE, Blackstone EH, Weintraub RG, Slavik Z, Scanlon J, Webber S. Relationship of the dimension of cardiac structures to body size: an echocardiographic study in normal infants and children. Cardiol Young 1999; 9: 402–410.Google Scholar
Chang AC, Farrell Jr PE, Murdison KA, et al. Hypoplastic left heart syndrome: hemodynamic and angiographic assessment after initial reconstructive surgery and relevance of modified Fontan procedure. J Am Coll Cardiol 1991; 17: 1143–1149.Google Scholar
Barber G, Helton JG, Aglira BA, et al. The significance of tricuspid regurgitation in hypoplastic left heart syndrome. Am Heart J 1988; 116 (6 pt 1): 1563–1567.Google Scholar
Reyes II A, Bove EL, Mosca RS, Kulick TJ, Ludomirsky A. Tricuspid valve repair in children with hypoplastic left heart syndrome during staged surgical reconstruction. Circulation 1997; 96: II341–II343.Google Scholar
Ghoussat A, Fontan F, Besse P, Vallot F, Chauve A, Bricaud H. Selection criteria for Fontan's operation: In: Anderson RH, Shinebourne EA (eds). Pediatric Cardiology 1977. Churchill Livingstone, Edinburgh, 1977, pp 559–566.