BIVENTRICULAR REPAIR OF LESIONS WITH STRADDLING TRICUSPID VALVES USING TECHNIQUES OF CORDAL TRANSLOCATION AND REALIGNMENT

Surgical management of straddling tricuspid valve and associated defec ts is a complex problem. Between August 1992 and August 1995, 5 patien ts with major straddling of the tricuspid valve underwent a complete o r partial biventricular repair. All patients had either an inlet ventr icular septal defect (n=4) or a ventricular septal defect with an inle t component (n=1). Go-existing cardiac lesions included hypoplasia of the right ventricle (n=3), discordant ventriculoarterial connections ( n=1), tetralogy of Fallot (n=1), and multiple muscular ventricular sep tal defects (n=2). At the time of presentation to our institution, two of these patients had previously been palliated in preparation for a Fontan procedure, having undergone construction of a bidirectional sup erior cavopulmonary shunt. One patient was referred specifically for a Fontan procedure. The tricuspid valve was repaired by transecting all of the straddling cords and reattaching them in the right ventricle o r onto the right side of the patch used to close the ventricular septa l defect. Associated procedures included closure of the septum in all patients, an arterial switch procedure in one, repair of tetralogy of Fallot in one, and construction of a bidirectional superior cavopulmon ary shunt in one. There has been no early or late mortality. Complete heart block requiring insertion of a pacemaker occurred after surgery in three patients. At a median follow-up of 32 months, functional inte grity of the tricuspid valve is well maintained, with only one patient having moderate tricuspid regurgitation. None of the patients are rec eiving any cardiac medication.