Repair of a quadricuspid truncal valve by tricuspidization and reconstruction of right ventricular outflow tract with the excised truncal cusp
Journal
Journal of Thoracic and Cardiovascular Surgery
Journal Volume
155
Journal Issue
3
Pages
1186-1189
Date Issued
2018
Author(s)
Abstract
Objective: Quadricuspid truncal valves are susceptible to regurgitation, and tricuspid configuration is considered more durable after repairing the truncal valve. We report a new method by excising the excessive truncal cuspid to reconstruct a new competent aortic valve. Methods: Bilateral pulmonary banding failed to stabilize a 4-month-old baby with type I truncus arteriosus and quadricuspid truncal valve with severe regurgitation, so surgery was performed. The aorta was transected, and the pulmonary arteries was separated from the aorta. There was an excessive cusp between the right coronary and left coronary cusp. A transannular incision was carried into the right ventricular outflow tract through the left border of the right coronary cusp. We performed truncal valve repair by translocating the excessive cusp, its annulus, and its wall to the right ventricular outflow tract side and reconstructing the neoaortic valve to tricuspid. Ventricular septal defect was repair through a right ventricular outflow tract approach. The floor of the right ventricular outflow tract was made from the excised cusp, including its wall and the resected posterior aortic wall. Then the anterior wall was reconstructed with bovine pericardial patch with a 19-mm porcine valve. Results: Postoperative echocardiography confirmed a tricuspid neo-aortic valve with trivial aortic regurgitation, no residual ventricular septal defect, and a patent right ventricular outflow tract. Conclusions: We present the surgical technique to repair a quadricuspid truncal valve insufficiency by using the excessive anterior cusp and its pedicled flap for reconstruction of the pulmonary pathway and restoration of the tricuspid truncal valve. ? 2017 The American Association for Thoracic Surgery
SDGs
Other Subjects
aorta; aortic regurgitation; aortic valve; aortic wall; arterial trunk; artery catheterization; Article; cardiopulmonary bypass; case report; clinical article; computer assisted tomography; heart right ventricle outflow tract; heart surgery; heart valve; heart valve regurgitation; heart ventricle septum defect; human; infant; male; myomectomy; palliative therapy; postoperative period; priority journal; pulmonary artery; quadricuspid truncal valve; right ventricle to pulmonary artery conduit; spiral computer assisted tomography; surgical technique; transesophageal echocardiography; tricuspidization; valvuloplasty; vein catheterization; aortic regurgitation; aortography; bioprosthesis; computed tomographic angiography; congenital heart malformation; convalescence; coronary angiography; devices; diagnostic imaging; heart right ventricle function; heart valve prosthesis; heart valve replacement; heart ventricle; hemodynamics; pathophysiology; pericardium; procedures; prosthesis design; severity of illness index; surgical flaps; transplantation; treatment outcome; xenograft; Aortic Valve; Aortic Valve Insufficiency; Aortography; Bioprosthesis; Computed Tomography Angiography; Coronary Angiography; Echocardiography, Transesophageal; Heart Defects, Congenital; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Heart Ventricles; Hemodynamics; Heterografts; Humans; Infant; Male; Pericardium; Prosthesis Design; Recovery of Function; Severity of Illness Index; Surgical Flaps; Treatment Outcome; Ventricular Function, Right
Publisher
Mosby Inc.
Type
journal article