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Tricuspid Valve Repair Improves Right Ventricular and Tricuspid Valve Remodeling in Patients with Hypoplastic Left Heart Syndrome
Shinya Ugaki, Nee Khoo, David Ross, *Ivan Rebeyka, Ian Adatia
Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada

Background: Tricuspid regurgitation (TR) is a significant risk factor for reoperation and mortality in patients with hypoplastic left heart syndrome (HLHS). The effects of tricuspid valve (TV) repair on quantitative measures of right ventricular and TV remodeling have not been well documented. Therefore, we sought to quantify right ventricular and TV remodeling pre and post TV repair in patients with HLHS.
Methods: We retrospectively reviewed two-dimensional echocardiograms performed 1 month before and after TV repair between 2005-11. From the apical 4 chamber view we measured right ventricular end-diastolic area (RVEDA), RV fractional area change (FAC), TV leaflet coaptation length, TR vena contracta width, TV tenting area and TV end-diastolic annular diameter. The severity of TR were graded qualitatively. We compared values pre and post TV repair using a paired t test.
Results: Nineteen patients underwent TV repair and 2 were excluded (1 died and 1 had inadequate echocardiograms). We analyzed the echocardiograms of 17 TV repairs (Male 12: Female 5, median age 30 months, range 1.5-53, median weight 13.0 kg, range 3.1-17.2). Concomitant procedures were performed in 14/17 and included modified Fontan operation, atrial septectomy, bidirectional Glenn, aortic arch repair. TV repair included annuloplasty (n=15) and/or cleft closure (n=5) and/or commissure closure (n=4).Detailed results are displayed in the table.
Conclusion: TV repair significantly improves the TV coaptation length of the lateral and septal leaflet, TV end-diastolic annular diameter, TV tenting area, TR vena contracta width and RVEDA in children with HLHS and moderate TR. TV repair impact favorably on quantitative markers of RV and TV remodeling. Further follow up on the decreased RV function is required to determine if this is a temporary phenomenon related to reduced RV preload or permanent RV dysfunction from late repair of the TV.
Pre TV repair
N=17
Mean ± SD
Post TV repair
N=17
Mean ± SD
P value
RVED area (cm2)14.1 ± 5.211.8 ± 3.9<0.01
RV FAC (%)44.4 ± 6.439.7 ± 8.5<0.01
TV end-diastolic annular diameter (mm)23.6 ± 3.919.8 ± 4.2<0.01
Coaptation length of the lateral leaflet (mm)0.4 ± 2.43.1 ± 2.7<0.01
Coaptation length of the septal leaflet (mm)2.0 ± 2.73.4 ± 2.00.02
TV tenting area (mm2)23.7 ± 26.010.5 ± 9.80.01
Vena contracta width (mm)5.4 ± 1.32.7 ± 1.8<0.01
TR graded (0 to 4)3.1 ± 0.61.7 ± 0.9<0.01


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