Chordal Replacement in Tricuspid Valve Repair in Children

Abstract

Congenital or traumatic tricuspid regurgitation in the pediatric population, although generally well tolerated initially, may lead ultimately to right atrial and ventricular dilation and dysfunction with dysrhythmias. In order to preserve right atrial and ventricular function and maintain sinus rhythm, it is our objective to repair the regurgitant tricuspid valve at an early stage. In 5 children (mean age 8.8 years) with congenital tricuspid regurgitation (2 with Ebstein's anomaly, 1 each with ventricular septal defect, tetralogy of Fallot, and partial agenesis of chordae), and in 1 child with traumatic tricuspid regurgitation, the shortened (n = 4), congenitally absent (n = 1), and ruptured (n = 1) chordae tendineae of the anterior or septal leaflets or both, were repaired with polytetrafluoroethylene artificial chordae. The tricuspid valve was successfully reconstructed in all 6 patients. De Vega's (n = 3) or Danielson's (n = 2) plication of the tricuspid valve annulus was performed in 5 patients. At a mean follow-up time of 15.7 months, tricuspid valve function was normal in 2 patients and the other 4 had mild residual tricuspid regurgitation. The mean diameter of the tricuspid annulus decreased from 36.7 mm preoperatively to 30.0 mm postoperatively, which is in the range for children with a normal tricuspid valve. In congenital or traumatic tricuspid regurgitation, chordal replacement using polytetrafluoroethylene artificial chordae is a useful adjunct to the armamentarium of tricuspid valve repair. Early repair avoids deterioration of right atrial and ventricular function and promotes maintenance of sinus rhythm.