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Tricuspid Valve Repair in Single Ventricle: Timing and Techniques

  • Victor T. Tsang
    Correspondence
    Address correspondence to Victor T. Tsang, MD, Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, WC1N 3JH, London, UK
    Affiliations
    Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, United Kingdom
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  • Shahzad G. Raja
    Affiliations
    Department of Cardiac Surgery, Harefield Hospital, London, United Kingdom; formerly a Cardiac Surgical Fellow at Great Ormond Street Hospital
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      Tricuspid valve performance in the systemic circulation is known to have important implications for survival and functional status after univentricular palliation of hypoplastic left heart syndrome (HLHS). Moderate to severe tricuspid valve regurgitation is not an uncommon finding in patients with HLHS undergoing staged surgical reconstruction. It can result from either abnormal valve morphology or incomplete leaflet coaptation, or both. But first and foremost, any aortic arch re-obstruction must be excluded. Development of significant tricuspid regurgitation (TR) remains an obstacle in improving survival after the Norwood procedure and likely compromised functional health after the Fontan procedure. Thus, surgical intervention for minimizing tricuspid valve deterioration and significant TR seems pivotal to improving long-term outcomes for patients with HLHS. This article provides an overview of the etiology and mechanisms of development of significant TR, natural history, indications for surgical intervention, and focuses on timing, techniques, and clinical outcomes of tricuspid valve repair in the setting of single ventricle.
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