De Vega Tricuspid Annuloplasty for Systemic Tricuspid Regurgitation in Children with Univentricular Physiology |
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| Background and aim of the study: Significant
tricuspid valve regurgitation (TR) is problematic in children with univentricular
physiology and a systemic tricuspid valve occasionally requiring tricuspid
(systemic atrioventricular) valve replacement. Since 1998, the De Vega
tricuspid annuloplasty technique has been applied for TR in these children. Methods: Twelve children (median age 2.2 years; range: 6 months to 17 years) with moderate or severe systemic TR underwent a De Vega tricuspid annuloplasty during a bidirectional Glenn anastomosis (n = 3), Fontan procedure (n = 8) or aortic valve replacement late after a Fontan procedure (n = 1). Nine patients (75%) had prior Norwood palliation for hypoplastic left heart syndrome. Four patients had simultaneous repair of an abnormal tricuspid valve in addition to the De Vega procedure. Results: There were no deaths during a mean follow up of 2.0 ± 1.4 years (range: 6 months to 5.1 years). |
One child required pacemaker implantation
early after operation, and one child with a Glenn anastomosis underwent
cardiac transplantation 21 months postoperatively. In the remaining 11
patients, the most recent echocardiogram showed mild or no TR in eight
children, mild-to-moderate TR in one child, and moderate TR in two children.
No child had symptomatic TR (including the two with moderate TR), significant
tricuspid stenosis, or late pacemaker implantation. Conclusion: The De Vega tricuspid annuloplasty safely provides excellent relief of systemic TR in children with univentricular physiology, with a majority of patients (73%) having mild or less residual TR at follow up examination. This simple technique is preferred to tricuspid (systemic) valve replacement in these children. |
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