De vega tricuspid annuloplasty for tricuspid regurgitation in children

Background. Significant tricuspid valve regurgitation (TR) occurs with othe r congenital heart defects, typically after repair of right-sided obstructi ve lesions. Since 1991, we applied the De Vega tricuspid annuloplasty techn ique for TR in children. Methods. Forty-one children, aged 5 months to 22.7 years (mean, 9.9 years) underwent 42 De Vega tricuspid annuloplasties for moderate or severe TR dur ing correction of other heart defects. One child had a De Vega during prima ry ventricular septal defect repair. The remaining patients had prior repai r of tetralogy of Fallot or pulmonary atresia, or both (19 patients), doubl e-outlet right ventricle (6 patients), pulmonary stenosis (4 patients), pul monary atresia and intact ventricular septum (3 patients), complete atriove ntricular septal defect (3 patients), and other diagnoses (6 patients). At the time of the De Vega, 37 patients (88%) had pulmonary valve replacement or right ventricular to pulmonary artery conduit replacement. Other procedu res included aortic or mitral repair or replacement (6 patients), atrial se ptal defect and ventricular septal defect closure (5 patients), pulmonary a rterioplasty (6 patients), and tracheoplasty (1 patient). Results. There were no deaths at follow-up of 3.4 +/- 2.1 years; 1 child re quired cardiac transplantation 17 months postoperatively. Early postrepair echocardiography quantified TR as absent or mild (34 patients; 81%), mild-t o-moderate (4 patients), moderate (3 patients), and severe (I patient). The most recent echocardiogram. showed moderate TR in 11 patients and severe T R in 2 patients (both with recurrent right ventricular hypertension). One c hild required tricuspid valve replacement 3 years later and 1 child had red o De Vega at the time of conduit re-replacement. No other child has symptom atic TR, significant tricuspid stenosis, or De Vega-related pacemaker impla ntation. Conclusions. The De Vega tricuspid annuloplasty safely provides excellent r elief of TR, usually in children undergoing pulmonary valve replacement or conduit replacement. Although echocardiographic TR tends to increase with t ime (especially with right ventricular hypertension), it rarely requires re intervention or causes symptoms. (C) 2001 by The Society of Thoracic Surgeo ns.