Replacement of the morphologically tricuspid valve in children with discordant atrioventricular connections

Background and aim of the study: Our clinical experience was reviewed to de termine the efficacy of replacement of the atrioventricular (AV) valve for the systemic circulation in children with discordant AV connections undergo ing functional biventricular repair. Methods: Nine children underwent replacement of the morphologically tricusp id valve at the age of 10 months to 15 years. Ventriculoarterial connection s were discordant in five children, and double outlet right ventricle with pulmonary stenosis or atresia in four. In all children the prosthesis chose n was a mechanical valve; valve sizes ranged from 19 mm to 31 mm. Results: One patient died of ventricular failure immediately after surgery. Two patients underwent reoperation for re-replacement at eight and 68 mont hs after the initial replacement because of non-structural dysfunction. Com plete AV block occurred after intracardiac maneuvers in the non-survivor. T ransient AV dissociation was noted in another patient. General conditions i mproved greatly after surgery in all survivors. In the morphologically righ t ventricle placed for the systemic circulation the end-diastolic volume fe ll from 327 +/- 182% (range: 109-621%) to 169 +/- 97% (range: 85-352%) of t he anticipated normal value (p = 0.03), while pressure fell from 13 +/- 4 ( range: 7-19) mmHg to 8 +/- 3 (range: 2-12) mmHg (p = 0.005). The ejection f raction was only marginally reduced (47 +/- 13% (range: 26-62%) preoperativ ely versus 34 +/- 11% (range: 20-54%) postoperatively; p = 0.13). Conclusions: In children with discordant atrioventricular connections and s evere regurgitation across the morphologically tricuspid valve, the valve c an be efficiently replaced for the systemic circulation.