Eastern Cardiothoracic Surgical Society

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LEAFLET DETACHMENT OF THE TRICUSPID VALVE DURING SURGICAL CLOSURE OF VENTRICULAR SEPTAL DEFECTS

Roy Varghese, Shilpa Sree.
Madras Medical Mission, Chennai, India.

Detachment of leaflets of the tricuspid valve is an established method to improve exposure of ventricular septal defects during surgical closure. However, there are concerns regarding tricuspid valvular competence, heart block and operating times. This study aims to popularize liberal use of this technique by showing results comparable to ones without detachment. The clinical records of 180 consecutive patients who underwent closure of ventricular septal defects were retrospectively analyzed. Of these 66 (36.7%) (Group A) required detachment of one or more leaflets. Patients whose leaflets were not detached were classified as Group B and constituted the rest. Patient characteristics were matched across both groups. Mean operating times as shown by cardiopulmonary and aortic cross clamp times were not significantly different across both groups (p values 0.473 and 0.5237 respectively). Postoperative Doppler echocardiography showed trivial tricuspid regurgitation in nine (27%) and 11 (18%) patients in Group A and B respectively. There were no residual defects or incidence of surgically induced heart block in either group. Mean duration of follow up was 10.16 months. Freedom from greater than trivial tricuspid regurgitation was 98%, 96% and 93% in Group A and 99%, 96% and 94% in Group B at 6, 12 and 24 months respectively. In conclusion, detachment of leaflets of the tricuspid valve is an adjunct to access margins of ventricular septal defects in selected patients.
TABLE 1
Clinical characteristics of patients

PARAMETERS GROUP A

n = 66
GROUP B

n = 114
AGE (Months)Mean: 16.22 27.29 SD
Median: 7
Range: 1 120
Mean: 42.38 70.82 SD
Median: 12
Range: 1 492
WEIGHT (Kgs)Mean: 7.19 5.03 SD
Median: 5.5
Range: 2.5 19.7
Mean: 10.75 9.88 SD Median: 7.35
Range: 2.6 38.2
ISOLATED VSD 44 37
TOF 12 59
TGA 04 06
TAPVC 02 0
DORV 04 08
INTERRUPTION OF ARCH 0 02
COA 0 02



TABLE 2
Clinical characteristics: infants
PARAMETERSGROUP A
n = 52
GROUP B
n = 66
AGE (Months)Mean: 5.16 3.77 SD
Median: 4
Mean: 7.84 4.05 SD
Median: 9
WEIGHT (Kgs)Mean: 5.22 1.86 SD
Median: 5.1
Range: 2.5 Kg 8.5
Mean: 6.03 2.19 SD
Median 6.27
Range: 2.6 10.2
ISOLATED VSD3418
TOF0836
TGA0404
TAPVC020
DORV0406
INTERRUPTION OF
ARCH
002

TABLE 3
Results

PARAMETERS

GROUP A
GROUP Bp value
Cardiopulmonary bypass time (minutes) 148.63 73.60 SD 176.57 79.47 SD 0.4733
Aortic cross clamp time
(minutes)
96.72 52.94 SD 111.73 46.21 SD 0.5237
POST OP TR
TRIVIAL
MILD
09
01
08
04
RESIDUAL VSD 00
HEART BLOCK 00
MORTALITY 0103
ICU STAY 3.27 1.66 days 4.01 2.38 days 0.1803

TABLE 4
Results: Isolated VSD's
PARAMETERSGROUP A GROUP Bp value
Cardiopulmonary bypass time (minutes) 126.86 59.76 SD114.33 59.11 SD 0.4702
Aortic cross clamp time
(minutes)
79.72 44.76 SD69.66 39.34 SD 0.9524
POST OP TR
TRIVIAL
MILD
02
0
0
0
RESIDUAL VSD0102
HEART BLOCK00
MORTALITY001
MILD TR010
MODERATE TR00

TABLE 5
Results: Infants

PARAMETERS

GROUP A
GROUP Bp value
Cardiopulmonary bypass time (minutes) 148.92 80.63 SD178.34 97.32 SD 0.3263
Aortic cross clamp time
(minutes)
92.88 52.54 SD110.87 57.64 SD 0.3312
POST OP TR
TRIVIAL
MILD
07
01
02
0
RESIDUAL VSD 001
HEART BLOCK 00
MORTALITY 0101
MILD TR 0303
MODERATE TR 00






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