Hostname: page-component-cd9895bd7-lnqnp Total loading time: 0 Render date: 2024-12-26T18:53:51.090Z Has data issue: false hasContentIssue false
  • English
  • Français

Mitral value anomalies in tricuspid atresia: an autopsy study of 54 hearts

Published online by Cambridge University Press:  19 August 2008

Robin J. Pinto ,
Jaya Deshpande  and
Bharat V Dalvi
Robin J. Pinto
Affiliation:
Department of Cardiology, King Edward VII Memorial Hospital, Parel, Bombay 400 012, India.
Jaya Deshpande
Affiliation:
Department of Cardiac Pathology, King Edward VII Memorial Hospital, Parel, Bombay 400 012, India.
Bharat V Dalvi*
Affiliation:
Department of Cardiology, King Edward VII Memorial Hospital, Parel, Bombay 400 012, India.
*
Dr Bharat Dalvi Associate Professor, Department of Cardiology, King Edwards VI Memorial Hospital, Parel Bombay 400 012, India. Tel: 91 022 413 6051 ext:2135. Fax: 91 022 414 3435.
Get access Rights & Permissions [Opens in a new window]

Abstract

Anatomic study of 54 autopsied cases of tricuspid atresia revealed mitral valvar anomalies in 9 (16.7%). The morphologic findings in these 9 cases are presented and compared with 45 cases having a normal mitral valvar apparatus. The anomalies included a cleft valve in 2, parachute valve in 2, straddling valve in 3, and a valve with dual orifice in 2.Two of these cases had more than one anomaly. Data from echocardiography and cardiac catheterisation, when available, had failed to diagnose the anomalies during life. The anomalies were more commonly associated with discordant ventriculo-arterial connections (33.3% versus 13.3%, p < 0.01), were associated significantly with a large ventricular septal defect (33.3% versus 4.4%, p < 0.01), and with pulmonary hypertension (33.3% versus 2.2%, p < 0.01). Two of 3 post operative deaths among the 9 were due to hemodynamic consequences arising from the uncorrected mitral valvar anomaly (parachute valve in both ). Diagnosis of these anomalies prior to surgical correction is imperative, as their presence may necessitate repair or replacement of the mitral valve. Failure to do so may result in increased perioperative mortality, congestive cardiac failure and arrhythmias at a later date. Mitral valvar anomalies may be a contributory factor to the early onset of cardiac failure seen in patients with tricuspid atresia undergoing palliative shunts.

Keywords

Tricuspid atresiamitral valvepapillary musclesstraddling valvedouble orifice mitral valvecleft mitral valve
Type
Original Articles
Information
Cardiology in the Young , Volume 7 , Issue 2 , April 1997 , pp. 163 - 171
Copyright
Copyright © Cambridge University Press 1997

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

1Choussat, A, Fontan, F, Besse, P, Valot, F, Chauve, F, Bricaud, H. Selection criteria for Fontan's procedure. In Anderson, RH, Shinebourne, EA, eds. Pediatric Cardiology. Churchill livinstone, Edinburgh: 1977;559–566.Google Scholar
2Fontan, F, Deville, C, Quaegebeur, J, Sourdille, N, Choussat, A, Brom, GA. Repair of tricuspid attesia in 100 patients. J Thorac Cardiovasc Surg 1983; 85: 647–660.CrossRefGoogle ScholarPubMed
3Jonas, RA, Castaneda, AR. Modified Fontan procedure: atrial baffle and systemic venous to pulmonary artery anastamitic techniques. J cardiac Surgery 1988; 3: 91–96.CrossRefGoogle ScholarPubMed
4Scalia, D, Rosso, P, Anderson, RH, Macartney, FJ, Hegerty, AS, Ho, SY, Daliento, L, Thiene, G. The surgical anatomy of hearts with no direct communication between the right atrium and the ventriclar mass - so-called tricuspid atresia. J Thorac Cardiovasc Surg 1984; 87: 743–755.CrossRefGoogle Scholar
5Sigfusson, G, Ettedgui, JA, Silverman, NH, Anderson, RH. Is a cleft in the anterior leaflet of an otherwise normal mitral valve an atriovcentricular canal malformation?. J am Collcardiol 1995; 26: 508–515.CrossRefGoogle ScholarPubMed
6Greenfield, WS. Double mitral valve. Trans Pathol Soc London 1876; 27: 128–129Google Scholar
7Bini, RM, Pellegrino, PA, Mazzucco, A, Gallucci, V, Milanesi, O, Maddalena, F, Thiene, G. Tricuspid atresia with double outlet left atrium. Chest 1980; 78: 109–111.CrossRefGoogle ScholarPubMed
8Milo, S, Ho, SW, Macartney, FJ, Wilkinson, JL, Becker, AE, Wenink, ACG, Gittenberger, de Groor AC, Anderson, RH. Straddling and overriding atrioventricular valves: morphology and classification. Am J Cardiol 1979; 44: 1122–1134.CrossRefGoogle Scholar
9Ruckman, RN, VanPraagh, R. Anatomic types of congenital mitral stenosis: report of 49 autopsy cases with considrations of diagnosis and surgical implications. Am J Cardiol 1978; 42: 592–601.CrossRefGoogle ScholarPubMed
10Soto, B, Becker, AE, Moulaert, AJ, Lie, JT, Anderson, RH: Classification of ventricular septal defects. Br Heart J 1980; 43: 332–343.CrossRefGoogle ScholarPubMed
11Anderson, RH, Wilkinson, JL, Gerlis, LM, Smith, A, Becker, AE. Atresia of the right atrioventicular orfice. Br Heart J 1977; 39: 414–428.CrossRefGoogle Scholar
12Coto, EO, Calabro, R, Marsico, F, Arranz, JL. Right atrial outlet atresia with straddling left atriovcentricular vlave: a form of double outlet atresia. Br Heart J 1981; 45: 317–234.CrossRefGoogle Scholar
13Dick, M, Fyler, DC, Nadas, As. Tricuspid atresia: the clinical course in 101 patients. Am J Cardiol 1975; 36: 327–337.CrossRefGoogle ScholarPubMed
14Ando, M, Satomi, G, Takao, A. Atresia of tricuspid or mitral orifice: anatomic spectrum and morphogenetic hypotheses. In Van Praagh, R, Takao, A, eds. Etiology and morphogenesis of Congenital Heart Disease. Futura, Mount Kisco, NY 1980; 421–487.Google Scholar
15VanPraagh, S, Vangi, V, Sul, JH, Metras, D, Parness, I, Castaneda, AR, Van Praagh, R. Tricuspid atresia or severe tensosis with partial common atrioventricular canal: natomic data, clinical profile and surgical considerations. J Am Coll Cardiol 1991; 17: 932–943.CrossRefGoogle Scholar
16Ho, SW, Milo, S, Anderson, RH, Macartney, FJ, Goodwin, A, Beker, AE, Wenink, ACG, Gere, LM, Wilkinson, JL. Straddling atrioventricular valve with absent striovcentricular connection: Report of 10 cases. Br Heart j 1982; 47: 344–355.CrossRefGoogle ScholarPubMed
17Shone, JD, Sellers, RD, Anderson, RC, Adams, P, Lillehei, CW, Edwards, JE. The development complex of parachate mitral valve, supravalvular ring ot left atrium, subaortic stensosis, and coarctation of aorta. Am J Cardiol 1963; 11: 714–725.CrossRefGoogle Scholar
18Bano-Rodrigo, A, VanPraagh, S, Trowitzsch, E, VanPraagh, R. Double orifice mitral valve: a study of 27 postmortem cases with develomental, diagnostic and surgical considerations. Am J Cardiol 1988; 61: 152–160.Google Scholar
19DeLeval, M, Bull, C, Hopkins, R, Rees, P, Deanfield, J, Taylor, JRN, Gersony, W, Stark, J, Macarteny, FJ. Decision making in the definitive repair of the heart with a small right ventricle. Cirulation 1985; 72(suppl II): 52–60.Google Scholar
20Tabry, IF, McGoon, DC, Danielson, GK, Wallece, RB, Tajik, AJ, Seward, JB. Surgical management of stradding atriocentricular valve. J Thorac Cardiovase Surg 1979 77: 191–201.CrossRefGoogle Scholar
21Stumper, O, Sutherland, GR, Geuskens, R, Roelandt, JRTC, Bos, E, Hess, J. Transesphageal echocardography in evaluation and management after a fontan procedure. J Am Coll Cardiol 1991; 17: 1152–1160.CrossRefGoogle Scholar