Desinserción parcial de válvula tricúspide para cierre de comunicación interventricular

Abstract

IntroductionVentricular septal defect closure through the right atrium might be cumbersome in the presence of redundant subvalvar apparatus. Partial tricuspid valve detachment to ease the defect closure is presented. MethodsRetrospective review of 156 patients with ventricular septal defect (82 isolated, 74 Fallot). 20 cases (9 isolated, 11 Fallot) had the tricuspid valve detached (12,8). Mean age and weight was 10,6 months and 7,13kg, respectively. The anterior tricuspid leaflet was electively, partially detached, thus providing a straightforward closure of the defect with Dacron patch (19 patients) or directly (1). Associated procedures: mid-ventricle muscle bundle resection (2), aortic valve re-attachment (2), Alfieri stitch (1) and mitral commisurotomy (1). ResultsMean extracorporeal time was 107minutes (range 61-153) and mean ischemic time was 58minutes (range 31-99). No residual ventricular septal defect, tricuspid regurgitation or aortic regurgitation was detected in intra-operative echographic assessment. One patient died due to sepsis. Another patient had a definite pacemaker implanted for complete heart block. Mean follow-up was 25 months, with no residual defects. ConclusionsPartial detachment of the anterior tricuspid leaflet is useful for right atrium closure of ventricular septal defect in difficult cases. This approach is optimal, rendering good results and little morbidity.