Abstract
The results of surgical treatment of 23 patients with iatrogenic tricuspid valve insufficiency after radical Fallots tetrad repair and repair of aorta and pulmonary artery outlet from right ventricle are presented. According to our study, the variety of tricuspid valve (TV) anatomic injuries is quite wide. It was proved by TV exploration after right atrium opening. Valve obturative function defect was caused by rough deformation of different cusps because of their involvement into suture fixing patch on VSD during previous procedure. Not only were the cusps deformed but subvalvular chordapapillary apparatus too. It was obvious that the reasons for tricuspid valve insufficiency were surgeons errors during suturing TV fibrous annulus when sewing low posterior sector of defect. Thin septal TV cusp tears because of wrong suturing beyond cusp. It is necessary to put sutures accurately beyond TV cusp base. To sum it up, iatrogenic tricuspid valve insufficiency after CHD of blue type repair is observed more and more often. It is connected with the increase in open heart surgery. The main reason for TV injuries are surgical errors during defect repair: breaking the rules of fixing patch on VSD and catching parts of TV into the suture.
References
1. Бокерия, Л. А. Современные тенденции развития хирургии сердца / Л. А. Бокерия // Анналы хир. - 1996. - № 1. - С. 10-18.
2. Бокерия, Л. А. Хирургическая анатомия сердца / Л. А. Бокерия, И. И. Беришвили. - Т. 3 - М., 2006. - С. 15-52.
3. Подзолков, В. П. Повторные операции после радикальной коррекции врожденных пороков сердца / В. П. Подзолков, В. Н. Чебан, А. А. Гаджиев и соавт. // Грудная и серд.- сосуд. хир. - 1996. - № 6. - С. 35-41.
4. Bernal, J. M. Reoperations after tricuspid valve repair / J. M. Bernal, D. Morales, C. Revuelta et al. // J. Thorac. Cardiovasc. Surg. - 2005. - Vol. 130. - P. 498-503.
5. Bharaty, S. The pathology of congenital heart disease / S. Bharaty et al. // Philadelphia: W. B. Saunders, 1997. - P. 199-226.
6. Chang, B. C. Long-term clinical results of tricuspid valve replacement / B. C. Chang, S. H. Lim, G. Yi et al. // Ann. Thorac. Surg. - 2006
7. De Bonis, M. A novel technique for correction of severe tricuspid valve regurgitation due to complex lesions / M. de Bonis, E. Lapenna, G. La Canna, A. et al. // Eur. J. Cardiothorac. Surg. - 2004. - Vol. 25, № 5. - P. 760-765.
8. DUdekem Y. Tricuspid valve repair for tricuspid valve endocarditis after Fallot repair / Y. dUdekem, T. Sluysmans, J. E. Rubay // J. Thorac. Cardiovasc. Surg. - 2005. - Vol. 130. - P. 498-503.
9. Filsoufi, F. Three-Dimensional Ring Annuloplasty for the Treatment of Tricuspid Regurgitation / F. Filsoufi, S. P. Salzberg // Ann. Thorac. Surg. - 2006. - Vol. 81. - P. 2273-2277.
10. Frater, R. Tricuspid insufficiency / R. Frater // J. Thorac. Cardiovasc. Surg. - 2001. - Vol. 122. - P. 427-429.
11. Kirklin, J. W. Cardiac. Surgery / J. W. Kirklin, B. G. Barratt- Boys - 2004.
12. Koichiro Niwa. Progressive Aortic Root Dilatation in Adults Late After Repair of Tetralogy of Fallot / Koichiro Niwa, S. C. Siu, G. D. Webb et al. // Circulation. - 2002. - Vol. 106. - P. 1374.
13. Messika-Zeitoun, D. Medical and surgical outcome of tricuspid regurgitation caused by flail leaflets / D. Messika-Zeitoun, H. Thomson et al. // J. Thorac. Cardiovasc. Surg. - 2004. - Vol. 128. - P. 296-302.
14. Stark J. Surgery of congenital heart defects / J. Stark, M. W. De Leval. - Philadelphia, B. Saunders Comp., 1994.
15. Toshiyuki Katogi. Surgical Management of Isolated Congenital Tricuspid / Toshiyuki Katogi, Ryo Aeba, Tsutomu Ito et al. //Regur. Ann. Thorac. Surg. - 1998. - Vol. 66. - P. 1571-1574.
16. Yoshikazu Hachiro. Reoperation for tricuspid regurgitation after total correction of tetralogy of fallot / Yoshikazu Hachiro, Nobuyuki Takagi, Tetsuya Koyanagi, Tomio Abe // Ann. Thorac. Cardiovasc. Surg. - 2002. - Vol. 8, № 4.
