Usefulness of the preoperative tricuspid/mitral ratio for predicting outcome in pulmonary atresia with intact ventricular septum

Although tricuspid valve z-scores have been used to predict outcome in pulm onary atresia with intact ventricular septum, they are statistically genera ted from local populations, and widespread generalization may not be approp riate. To determine if there are echocardiographic predictors of outcome th at can be universally used, the records of all infants with this diagnosis since 1988 were reviewed for age, weight, type of surgery, and outcome. Pre operative and follow-up echocardiograms were reviewed for valve diameter an d I-scores, and valve ratios were calculated. thirty-six patients were divi ded into 2 groups: group 1 included 23 infants who had a successful biventr icular repair; group 2 included the remaining 13 infants who did not have a successful repair. Preoperatively, both groups had similar ages, pulmonary , aortic, and mitral z-scores, and pulmonary/aortic ratios, but the patient s in group 2 had significantly lower weight (3.5 +/- 0.6 vs 2.9 +/- 0.5 kg) , tricuspid z-scores (-0.7 +/- 1.5 vs -2.3 +/- 1.2), and tricuspid/mitral r atios (0.8 +/- 0.2 vs 0.5 +/- 0.1). At similar follow-up, both groups of pa tients had similar weight, aortic and mitral z-scores, and pulmonary/aortic ratios, but group 2 infants had significantly lower pulmonary and tricuspi d z-scores and tricuspid/mitral ratios. Compared with the preoperative echo cardiograms, group 1 had significant increases only in pulmonary z-scores, and pulmonary/aortic and tricuspid/mitral ratios. Group 2 had no significan t change in any echocardiographic variable. The tricuspid/mitral ratio wets >0.5 in all group 1 infants, and in 6 of 13 group 2 infants (2 sepsis deat hs, 4 palliations). Compared with a tricuspid valve z-score >-3, a tricuspi d/mitral ratio >0.5 was a better predictor of biventricular repair. Thus, i nfants who have a successful biventricular repair have significantly greate r preoperative weight, tricuspid valve z-scores, and tricuspid/mitral valve ratios. A tricuspid/mitral ratio >0.5 was the best predictor of a biventri cular repair. (C) 2000 by Excerpta Medico, Inc.