Replacement of the Morphologically Tricuspid Valve in Children
with Discordant Atrioventricular Connections
Satoshi Numata MD, Hideki Uemura MD, Toshikatsu Yagihara MD,
Youichi Kawahira MD, Yoshiro Yoshikawa MD, Soichiro Kitamura MD

The efficacy of replacing the atrioventricular (AV) valve for the systemic circulation in children with discordant AV connections undergoing functional biventricular repair was reviewed. Nine children (aged 10 months to 15 years) underwent replacement of the morphologically tricuspid valve. Ventriculoarterial connections were discordant in five children, and double outlet right ventricle with pulmonary stenosis or atresia in four. All children received a mechanical valve (19 mm to 31 mm). One patient died of ventricular failure immediately after surgery. Two patients had re-replacement at eight and 68 months after the initial replacement because of non-structural dysfunction. General conditions improved greatly after surgery in all survivors. In the morphologically right ventricle placed for the systemic circulation the mean end-diastolic volume fell from

327 ± 182% to 169 ± 97% of the anticipated normal value (p = 0.03); mean pressure fell from 13 ± 4 mmHg to 8 ± 3 mmHg (p = 0.005). The ejection fraction was only marginally reduced (47 ± 13% versus 34 ± 11%; p = 0.13). Thus, in children with discordant atrioventricular connections and severe regurgitation across the morphologically tricuspid valve, the valve can be efficiently replaced for the systemic circulation.