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Retrospective analysis of stage I Norwood procedures with tricuspid valve insufficiency in the past 5 years

Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka City, Shizuoka, 420-8660 Japan

*Corresponding author. Tel.: +81-54-247-6251; fax: +81-54-247-6259.

E-mail address: Sakamoto{at}jun.ncvc.go.jp (K. Sakamoto).

Moderate/severe tricuspid valve regurgitation is one of the important risk factors affecting outcome after the Norwood procedure. We now evaluate tricuspid valves more precisely echocardiographically and manage tricuspid valve regurgitation even when performing the stage I Norwood procedure. We reviewed all patients (tricuspid valve regurgitation moderate/severe group=10, mild/trivial non-regurgitation group=19) who underwent the stage I Norwood procedure with a ventricle to pulmonary artery conduit in our institution between January 2001 and March 2006. Four of 10 patients with tricuspid valve regurgitation underwent tricuspid valvuloplasty in the stage I procedure. We controlled pulmonary flow in all patients with tricuspid valve regurgitation by clipping the conduit. Tricuspid valve regurgitation improved significantly after the stage I Norwood procedure in all patients (P<0.01). Operative mortality was similar in the two groups. There were no significant differences of the actuarial overall survival rate in both groups (P=0.38, log-rank test). Follow-up is complete in all patients. The rate of final repair completion was similar in the two groups (regurgitation, 5/10; non-regurgitation, 10/19). Appropriate pulmonary flow control and surgical repair in the Norwood procedure improved the outcome in terms of postoperative survival in patients with hypoplastic left heart syndrome who had moderate/severe tricuspid valve regurgitation.

Key Words: Hypoplastic left heart syndrome; Tricuspid valve regurgitation; Tricuspid valvuloplasty