Avaliaçäo pós-operatória imediata da influência da desinserçäo da valva tricúspide no tratamento da comunicaçäo interventricular / Immediate postoperative evaluation of the tricuspid valve takedown insuficiency in the treatment of the ventricular septal defect

RESUMO

Although the tricuspid valve and its attachments can sometimes obscure the margins of the ventricular septal defect from the vision of the surgeon, concern for valvular competence has made surgeons hesitate to take down the tricuspid valve. In this paper, the records of 34 patients divided into two groups (comparable by gender, age and associated anomalies) were reviewed retrospectively. Treatment of the ventricular septal defect was done without (Group I, with 19 patients) and with (Group II, with 15 patients) takedown of the tricuspid valve to determine the degree of the tricuspid regurgitation and also the incidence of residual ventricular septal defects and atrioventricular block. The anterior and septal leaflets of the valve were taken down at the annulus and resuspended after VSD repair with running 6-0 polypropylene sutures. The degree of valvular regurgitation and the presence of residual VSD were determined by echo done on post-operative day one and at the the patient's discharge. Valvular regurgitation was graded as none in 12 patients of the Group I and in 10 patients of the Group II; trivial regurgitation in 5 patients of Group I and 4 of Group II; mild to moderate regurgitation in 2 cases of Group I and 1 in Group II. No patient had severe regurgitation. Even with a small number of cases, there was no statistically significant difference between the groups. There was only one case of residual VSD in Group I with spontaneous closure. The mortality in Group I was 10.5 per cent and 6.6 per cent in Group II. The authors conclude that takedown and re-suspension of the tricuspid valve in VSD repair surgery does not adversely affect valve competence neither increases the incidence of residual VSD or the incidence of A-V block.