SURGICAL TREATMENT OF TRICUSPID VALVE DYSFUNCTION AFTER TOTAL CORRECTION OF CONGENITAL HEART DISEASE

Objective. To study the morphological changes of tricuspid valve (TV) and biological prosthesis in the position of TV, to determine the risk factors of insufficiency and to present an analysis of the results of repeated operations in TV in patients after previously performed complete correction of congenital heart defect (CHD). Material and methods. From January 2000 to December 2015 we conducted 86 operations on TV after earlier performed complete correction of congenital heart defects. The mean age of the patients was 24.9 ± 14.2 years (range 3 to 65). Among them, 39 (45.3%) were female and 47 (54,7%) were male. Functional and organic changes of TV were indications for reconstructive operations. Reprosthesis was performed in 24 (28%) patients. In all cases the preoperative echocardiography registered 2-4 degree of regurgitation. Оригинальная статья Results. Plasty of TV was performed in 30 (34.9%) patients, of which in 2 cases it was repeated. Prosthetics of TV was carried out in 56 patients (65.1%), and in 24 cases it was repeated. In 12 patients redo prosthetics was performed 3 times. In the early postoperative period, in 23 patients (26.7%) the following non-lethal complications were observed: the syndrome of low cardiac output (9 cases), rhythm disturbances requiring pacemaker implantation (9 cases), stroke (2 cases), spontaneous pneumothorax (2 cases), and postoperative bleeding (1 case). Overall survival after 5, 10 and 15 years was 91, 86 and 81%, respectively. Conclusion. Surgical treatment of tricuspid insufficiency after complete correction of CHD should be performed prior to the development of severe heart failure, thus reducing the percentage of right ventricle dysfunction. To date the question remains, in what cases replasty of TV should be performed, and when to resort to prosthetics. The development of the plan of future operations and the choice of an optimal surgical approach will contribute to reducing the number of complications and the risk of repeated interventions.

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