Hostname: page-component-cd9895bd7-8ctnn Total loading time: 0 Render date: 2024-12-28T12:18:59.533Z Has data issue: false hasContentIssue false
  • English
  • Français

Congenital tricuspid regurgitation: review and a proposed new classification

Published online by Cambridge University Press:  22 December 2010

Anubhav Gupta ,
Vijay Grover  and
Vijay K. Gupta
Anubhav Gupta*
Affiliation:
Department of Cardiothoracic and Vascular Surgery, Dr RML Hospital, Postgraduate Institute of Medical Education and Research, Baba Kharak, Connaught Place, New Delhi, India
Vijay Grover
Affiliation:
Department of Cardiothoracic and Vascular Surgery, Dr RML Hospital, Postgraduate Institute of Medical Education and Research, Baba Kharak, Connaught Place, New Delhi, India
Vijay K. Gupta
Affiliation:
Department of Cardiothoracic and Vascular Surgery, Dr RML Hospital, Postgraduate Institute of Medical Education and Research, Baba Kharak, Connaught Place, New Delhi, India
*
Correspondence to: Dr A. Gupta, Assistant Professor, Department of Cardiothoracic and Vascular Surgery, Dr RML Hospital, Postgraduate Institute of Medical Education and Research, Baba Kharak Singh Marg, Connaught Place, New Delhi – 110001, India. Tel: +91 11 23404480; Fax: +91 11 23747882; E-mail: dr.anubhav.gupta@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Background and aim

Congenital tricuspid regurgitation is an extremely rare condition. The morphologic heterogeneity makes it difficult to derive any conclusions regarding the best strategy for management of this condition.

Methods

We analysed the published literature on “congenital tricuspid regurgitation” using MEDLINE. In addition, the reference sections of all relevant articles were searched to identify additional cases. Studies published till June 2009 are included.

Results

As far as we could establish, there were 123 cases of congenital tricuspid regurgitation. Of these, 63 were documented during surgery, 38 during autopsy, and 22 were diagnosed by echocardiography or cardiac catheterisation. The mean age was 22.57 years, with a standard deviation of 23.42 years, and the age ranged from 1 day to 80 years, with a median of 16 years. There was a male predominance, with a male-to-female ratio of approximately 3:2.

Conclusion

Congenital tricuspid regurgitation is an uncommon clinical entity with wide anatomical variations. The severity of disease dictates the presentation in infancy, childhood, or adulthood. Tricuspid valve repair is the ideal treatment whenever feasible, especially in children. We propose a new classification for congenital tricuspid regurgitation, which not only includes the anatomical variations, but can also help the surgeon in deciding on the best strategy for management.

Keywords

Cardiac diseasevalvular regurgitationmanagement
Type
Review
Information
Cardiology in the Young , Volume 21 , Issue 2 , April 2011 , pp. 121 - 129
Copyright
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Aaron, BL, Mills, M, Lower, RR. Congenital tricuspid insufficiency: definition and review. Chest 1976; 69: 637–641.CrossRefGoogle ScholarPubMed
2. Becker, AE, Becker, MJ, Edwards, JE. Pathologic spectrum of dysplasia of the tricuspid valve. Arch Pathol 1971; 91: 167–178.Google ScholarPubMed
3. Waller, BF, Bloch, T, Backer, BG, Roe, SJ, Brown, JW, Mahomed, Y. Evaluation of operated excised cardiac valves: etiologic determination of valvular heart disease. Cardiol Clin 1984; 2: 687–716.CrossRefGoogle ScholarPubMed
4. Hauck, AJ, Freeman, DP, Ackermann, DM, Danielson, GK, Edwards, WD. Surgical pathology of the tricuspid valve: a study of 363 cases spanning 25 years. Mayo Clin Proc 1988; 63: 851–863.CrossRefGoogle ScholarPubMed
5. Urban, CH. Congenital tricuspid insufficiency. J Forensic Sci 1904; 9: 396–401.Google Scholar
6. Hotz, A. Uber angeborene Trikuspidalinsuffiziem. Jahrbuch fur Kinderheilkunde 1923; 102: 1–12.Google Scholar
7. Ariel, MB. Ein seltener Fall von angeborenem Herzfehler bei einem Neugeborenen. Virchow's Path Anat 1930; 277: 501–506.CrossRefGoogle Scholar
8. Abbott, ME. Atlas of Congenital Cardiac Disease. American Heart Association, New York, 1936, p 24.Google Scholar
9. Dubin, IN, Hollinshead, WH. Congenitally insufficient tricuspid valve accompanied by an anomalous septum in the right atrium. Arch Path 1944; 38: 225–228.Google Scholar
10. Palladino, VS, Kinney, TD. Cardiac hypertrophy and congenital tricuspid insufficiency; report of two cases. Bull Internat AM Mus 1948; 28: 23–33.Google Scholar
11. Barritt, DW, Urich, H. Congenital tricuspid incompetence. Br Heart J 1956; 18: 133–138.CrossRefGoogle ScholarPubMed
12. Kincaid, OW, Swan, HJC, Ongley, PA, et al. Congenital tricuspid insufficiency; report of two cases. Proc Staff Meeting Mayo Clinic 1962; 37: 840–850.Google ScholarPubMed
13. Reisman, M, Hipona, FA, Bloor, CM, et al. Congenital tricuspid insufficiency. J Pediatr 1965; 66: 869–876.CrossRefGoogle ScholarPubMed
14. Jordan, JD, Taylor, WT. Case of combined congenital tricuspid and mitral insufEciency. Am J Dis Child 1966; 111: 105–108.Google Scholar
15. Sanyal, SK, Bhargava, SK, Saxena, H, et al. Congenital insufficiency of the tricuspid valve. Indian Heart J 1968; 20: 214–218.Google Scholar
16. Antia, AU, Osunkoya, BO. Congenital tricuspid incompetence. Br Heart J 1969; 31: 664–666.CrossRefGoogle ScholarPubMed
17. Barr, PA, Celermajer, MB, Bowdler, JD, et al. Severe congenital tricuspid incompetence in the neonate. Circulation 1974; 49: 962–967.CrossRefGoogle ScholarPubMed
18. Kanjuh, V, Stevenson, JE, Amplatz, K, Edwards, JE. Congenitally unguarded tricuspid orifice with coexistent pulmonary atresia. Circulation 1964; 30: 911–917.CrossRefGoogle ScholarPubMed
19. Green, EW, Ziegler, RF, Mieher, WC. Physiologic and anatomic considerations in congenital tricuspid valvular defects. Circulation 1962; 26: 723.Google Scholar
20. Tutarel, O, Westhoff-Bleck, M. The double-orifice tricuspid valve: a review. J Heart Valve Dis 2007; 16: 508–510.Google ScholarPubMed
21. Boon, R, Hazekamp, M, Hoohenkerk, G, et al. Artificial chordae for paediatric mitral and tricuspid valve repair. Eur J Cardiothorac Surg 2007; 32: 143–148.CrossRefGoogle ScholarPubMed
22. Ootaki, Y, Yamaguchi, M, Yoshimura, N, Oka, S, Yoshida, M, Hasegawa, T. Tricuspid valve repair with papillary muscle shortening for severe tricuspid regurgitation in children. Ann Thorac Surg 2004; 78: 1486–1488.CrossRefGoogle ScholarPubMed
23. Motoyoshi, N, Tofukuji, M, Sakurai, M, Ohmi, M, Koichi, T. Cleft of tricuspid anterior leaflet. Ann Thorac Surg 2001; 71: 1350–1351.CrossRefGoogle ScholarPubMed
24. Honjo, O, Ishino, K, Yoshizumi, K, et al. Repair of dysplastic tricuspid valve using artificial chordae: case report. J Heart Valve Dis 2006; 15: 392–393.Google ScholarPubMed
25. Shibata, Y, Sato, M, Chanda, J, Sato, S, Fujiwara, R. Isolated tricuspid regurgitation due to atypical morphology of anterior-posterior leaflets in an adult: a case report and review of literature. J Cardiovasc Surg 1999; 40: 527–530.Google Scholar
26. Okutan, H, Yavuz, T, Bigin, S, Duver, H, Kutsal, A. Congenital cleft of anterior tricuspid leaflet in adolescent. Asian Cardiovasc Thorac Ann 2002; 10: 262–263.CrossRefGoogle ScholarPubMed
27. Abrams, DJ, Kilner, P, Till, JA, et al. Prolapse of the antero-superior leaflet of the tricuspid valve secondary to congenital anomalies of the valvar and sub-valvar apparatus: a rare cause of severe tricuspid regurgitation. Cardiol Young 2005; 15: 417–421.CrossRefGoogle ScholarPubMed
28. Katogi, T, Aeba, R, Ito, T, et al. Surgical management of isolated congenital tricuspid regurgitation. Ann Thorac Surg 1998; 66: 1571–1574.CrossRefGoogle ScholarPubMed
29. Eichhorn, P, Ritter, M, Suetsch, G, von Segesser, LK, Turina, M, Jenni, R. Congenital cleft of the anterior tricuspid leaflet with severe tricuspid regurgitation in adults. J Am Coll Cardiol 1992; 20: 1175–1179.CrossRefGoogle ScholarPubMed
30. Mantovani, V, Grossi, C, Ferrarese, S, Sala, A. Edge-to-edge repair of congenital familiar tricuspid regurgitation: case report. J Heart Valve Dis 2000; 9: 641–643.Google ScholarPubMed
31. McElhinney, DB, Silverman, NH, Brook, MM, Hanley, FL, Stanger, P. Asymmetrically short tendinous cords causing congenital tricuspid regurgitation: improved understanding of tricuspid valvar dysplasia in the era of color flow echocardiography. Cardiol Young 1999; 9: 300–304.CrossRefGoogle ScholarPubMed
32. Kobza, R, Kurz, DJ, Oechslin, EN, et al. Aberrant tendinous chordae with tethering of the tricuspid leaflets: a congenital anomaly causing severe tricuspid regurgitation. Heart 2004; 90: 319–323.CrossRefGoogle ScholarPubMed
33. Montero, CG, Tellez, G, Simarro, E, et al. A new technique for reconstruction of the tricuspid valve ring in congenital tricuspid insufficiency. Tex Heart Inst J 1983; 10: 209–213.Google ScholarPubMed
34. Aoyagi, S, Maruyama, H, Akasu, K, Kawara, T. Isolated tricuspid valve regurgitation resulting from severe annular dilatation: case report. J Heart Valve Dis 1999; 8: 457–459.Google ScholarPubMed
35. Sakai, K, Inoue, Y, Osawa, M. Congenital isolated tricuspid regurgitation in an adult. Am Heart J 1985; 110: 680–681.CrossRefGoogle ScholarPubMed
36. Hung, MJ, Kuo, LT, Wang, CH, Cherng, WJ. Reversible left ventricular function after tricuspid valve replacement for a patient with congenital isolated severe tricuspid regurgitation. Echocardiography 2002; 19: 517–520.CrossRefGoogle ScholarPubMed
37. Pernot, C, Hoeffel, JC, Henry, M, Piwnica, A. Congenital tricuspid insufficiency. Cardiovasc Radiol 1978; 1: 37–44.CrossRefGoogle Scholar
38. Yang, X, Wu, Q, Xu, J, Shen, X, Gao, S, Liu, F. Repair of flail leaflet of tricuspid valve by simple cusp remodelling technique. J Card Surg 2007; 22: 333–335.CrossRefGoogle Scholar
39. Reddy, VM, McElhinney, DB, Brook, MM, Silverman, NH, Stanger, P, Hanley, FL. Repair of congenital tricuspid valve abnormalities with artificial chordae tendinae. Ann Thorac Surg 1998; 66: 172–176.Google Scholar
40. Girard, SE, Nishimura, RA, Warnes, CA, Dearani, JA, Puga, FJ. Idiopathic annular dilation: a rare cause of isolated severe tricuspid regurgitation. J Heart Valve Dis 2000; 9: 283–287.Google ScholarPubMed
41. Yokoyama, S, Akimoto, T, Takemura, T, Harada, Y. A surgical case report of isolated congenital tricuspid valve insufficiency. J Jpn Assn Thorac Surg 1995; 43: 1063–1068.Google ScholarPubMed
42. Boucek, RJ Jr, Graham, TP Jr, Morgan, JP, Atwood, GF, Boerth, RC. Spontaneous resolution of massive congenital tricuspid insufficiency. Circulation 1976; 54: 795–800.CrossRefGoogle ScholarPubMed
43. Kilic, A, Ozkutlu, S, Gunal, N. Unguarded tricuspid orifice diagnosed by echocardiography: a clinical study. Turk J Pediatr 2000; 42: 227–229.Google ScholarPubMed
44. Ozkutlu, S, Gunal, N, Caglar, M, Alehan, D, Gungor, C. Unguarded tricuspid orifice: a rare malformation of tricuspid valve diagnosed by echocardiography. Report of two cases and review of literature. Int J Cardiol 1996; 56: 125–129.CrossRefGoogle Scholar
45. Lang, D, Oberhoffer, R, Cook, A, et al. Pathologic spectrum of malformations of the tricuspid valve in prenatal and neonatal life. J Am Coll Cardiol 1991; 17: 1161–1167.CrossRefGoogle ScholarPubMed
46. Lagarde, O, Garabedian, V, Coignard, A, Duret, JC, Piwnica, A, Droniou, J. Congenital tricuspid insufficiency due to valvular dysplasia. Review of the literature in light of a case in a 40-year-old adult. Arch Mal Coeur Vaiss 1980; 73: 387–396.Google Scholar
47. McGrath, LB, Gonzales-Lavin, L, Bailey, BM, Grunkemeier, GL, Fernandez, J, Laub, GW. Tricuspid valve operations in 530 patients: twenty-five-year assessment of early and late phase events. J Thorac Cardiovasc Surg 1990; 99: 124–133.CrossRefGoogle ScholarPubMed
48. Van Nooten, GJ, Caes, F, Taeymans, Y, et al. Tricuspid valve replacement: postoperative and long-term results. J Thorac Cardiovasc Surg 1995; 110: 672–679.CrossRefGoogle ScholarPubMed
49. Pasque, M, Williams, WG, Coles, JG, Trusler, GA, Freedom, RM. Tricuspid valve replacement in children. Ann Thorac Surg 1987; 44: 164–168.CrossRefGoogle ScholarPubMed
50. Fundaro, P, Di Mattia, GG, Salati, M, Santoli, C. Free edge suture plication and remodelling: a technique for anterior leaflet prolapse repair. Ann Thorac Surg 1997; 63: 1186–1188.CrossRefGoogle Scholar
51. Castedo, E, Cañas, A, Cabo, RA, Burgos, R, Ugarte, J. Edge-to-edge tricuspid repair for redeveloped valve incompetence after De Vega's annuloplasty. Ann Thorac Surg 2003; 75: 605–606.CrossRefGoogle Scholar
52. Klein, H. Uber einen seltenen Fall von herzmissbildung mit rudimentarer entwicklung des rechten ventrikels und defect der tricuspidal klappen. Virchows Arch 1938; 310: 1–36.CrossRefGoogle Scholar
53. Anderson, RH, Silverman, NH, Zuberbuhler, JR. Congenitally unguarded tricuspid orifice: its differentiation from Ebstein's malformation in association with pulmonary atresia and intact ventricular septum. Pediatr Cardiol 1990; 11: 86–90.CrossRefGoogle ScholarPubMed
54. Cascos, AS, Rabago, P, Sokolowski, M. Duplication of the tricuspid valve. Br Heart J 1976; 29: 943.Google Scholar
55. Pignoni, P, Carraro, R, Nicolosi, GL. Prolapse of atrioventricular valve leaflets in the setting of double orifice. Int J Cardiol 1988; 19: 115–119.CrossRefGoogle ScholarPubMed
56. Lynch, TG, Doty, DB. Duplication of the tricuspid valve. Cardiovasc Dis 1980; 7: 159–164.Google ScholarPubMed
57. Goldberg, N, Schifter, D, Aron, M, Shapiro, RS, Krasnow, N, Stein, RA. Double orifice mitral and tricuspid valves. Echocardiography 1996; 13: 85–90.CrossRefGoogle ScholarPubMed
58. Badano, LP, Agricola, E, Perez de Isla, L, Gianfagna, P, Zamorano, JL. Evaluation of the tricuspid valve morphology and function by transthoracic real-time three-dimensional echocardiography. Eur J Echocardiogr 2009; 10: 477–484.CrossRefGoogle ScholarPubMed
59. Anwar, AM, Geleijnse, ML, Soliman, OI, et al. Assessment of normal tricuspid valve anatomy in adults by realtime three-dimensional echocardiography. Int J Cardiovasc Imaging 2007; 23: 717–724.CrossRefGoogle ScholarPubMed