Lr. Prieto et al., PROGRESSIVE TRICUSPID-VALVE DISEASE IN PATIENTS WITH CONGENITALLY CORRECTED TRANSPOSITION OF THE GREAT-ARTERIES, Circulation, 98(10), 1998, pp. 997-1005
Citations number
26
Categorie Soggetti
Peripheal Vascular Diseas",Hematology,"Cardiac & Cardiovascular System
Background-The outcome of patients with corrected transposition of the
great arteries (CTGA) is variably affected by associated intracardiac
defects, tricuspid valve competence, and systemic right ventricular (
RV) function. The relative importance of these factors in long-term ou
tcome has not been evaluated. Methods and Results-Since 1958, 40 patie
nts with CTGA were studied to determine risk factors for poor outcome,
including age, open heart surgery, tricuspid insufficiency (TI), card
iac rhythm, pulmonary overcirculation, and RV dysfunction. Follow-up r
anged from 7 to 36 years (mean 20 years). Intracardiac repair was perf
ormed in 21 patients; 19 were unoperated or had closed heart procedure
s. For the purposes of this study the designation TIs refers to at lea
st moderately severe TI as delineated by echocardiogram and/or angiogr
aphy. TIs was the only independently significant factor for death (P=0
.01), and in turn, only the presence of a morphologically abnormal TV
predicted TIs (P=0.03), Twenty-year survival without TIs was 93%, but
only 49% with TIs. Poor long-term postoperative outcome was due to TIs
in all but 1 patient; 20-year survival rates for operated patients wi
th and without TIs were 34% and 90%, respectively (P=0.002). Similarly
, 20-year survival rates for unoperated patients with and without TIs
were 60% and 100%, respectively, whether or not attempts to repair the
TI were made (P=0.08). Conclusions--TIs represents the major risk fac
tor for CTGA patients; RV dysfunction appears to be almost always seco
ndary to long-standing TI. Decisions related to surgical interventions
with or without associated lesions must be strongly influenced by the
status of the tricuspid valve.