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DOI: 10.1055/s-0031-1297680
Unloading of the right ventricle by PCPC does not improve tricuspid insufficiency in HLHS patients
Purpose: The objective of this study was to evaluate the influence of volume unloading by partial cavopulmonary connection (PCPC) on the tricuspid insufficiency (TI) in patients with hypoplastic left heart syndrome (HLHS).
Methods: Ninety HLHS patients, who received PCPC between 2001 and 2010 and survived the early postoperative period, were included in this retrospective study. In 7 patients surgery for severe tricuspid insufficiency (grade IV) was necessary before or at the time of PCPC. The echocardiograms of the remaining patients (n=83) were reevaluated for tricuspid insufficiency before PCPC and at the last available follow-up before total cavopulmonary connection (TCPC).
Results: Ultrasounds before PCPC were done at median of 5 days before the operation (range 0–25 days). TI was graded as 0 in 11 patients, I in 37 patients, II in 24 patients and III in 11 patients. Follow-up ultrasounds were performed at median of 17 months after PCPC (range 7 days –57 months). TI was graded as 0 in 14 patients, I in 37 patients, II in 21 patients, III in 6 patients and IV in 5 patients. There was no significant change in the level of TI after PCPC alone compared to the preoperative data (p=0.68 for the patients with TI II or more, p=1.00 for the patients with TI III or more).
Conclusion: Volume unloading of the right ventricle by PCPC in HLHS patients does not lead to a reduction of tricuspid insufficiency. Significant tricuspid regurgitation should be repaired at the time of PCPC.