Early and Mid-term Outcomes of Morphologic Tricuspid Valve Replacement with Preservation of Entire Valvular and Subvalvular Apparatus in Corrected Transposition of Great Arteries_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WEI Yu , XU Jianping

Department of Cardiovascular Surgery，Fu Wai Hospital，Chinese Academy of Medical Sciences &;
Peking Union Medical College， Beijing 100037，P. R. China;

Corresponding author：

Keywords：

Corrected transposition of great arteries; Intravalvular implantation of prosthesis; Morphologic tri cuspid valve replacement

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Abstract： Objective To investigate the early and mid-term outcomes of morphologic tricuspid valve replacement by means of intravalvular implantation in corrected transposition of great arteries（cTGA）. Methods From January 2009 to January 2012，11 patients with cTGA were surgically treated in Fu Wai Hospital. There were 9 male patients and 2 female patients with their mean of age of（37.8±11.7）years and mean body weight of（73.0±11.3）kg. All the patients underwent morphologic tricuspid valve replacement with preservation of the entire valvular and subvalvular apparatus. Simultaneous surgical procedures included repair of ventricular septal defect in 2 patients，repair of atrial septal defect in 4 patients，pulmonary valvuloplasty in 1 patient，reconstruction of functional right ventricular outflow tract in 4 patients and repair of coronary-pulmonary artery fistula in 1 patient. Postoperative New York Heart Association （NYHA） classification, cardiothoracic ratio, morphological right ventricle ejection fraction, end-diastolic dimension of morphological right ventricle and left atrium were evaluated during follow-up. Results All the 11 patients were successfully surgically treated and followed up for an average duration of（13.0±10.6）months. There was no statistical difference between postoperative and preoperative average cardiothoracic ratio （0.54±0.06 vs. 0.57±0.09，t=1.581，P＞0.05），morphologic right ventricle ejection fraction （52.8%±9.0% vs. 54.9%±9.5%, t =0.712，P＞0.05），and end-diastolic dimension of . morphological right ventricle （54.3±7.5 mm vs. 56.9±9.2 mm，t =0.988，P＞0.05）. There was statistical difference between postoperative and preoperative average end-diastolic dimension of left atrium（42.1±8.9 mm vs. 53.4±11.1 mm，t =3.286，P＜0.05）and NYHA classification（Z = -2.640，P＜0.05）. Conclusion Intravalvular implantation of morphologic tricuspid prosthesis can protect the physiological structure of morphologic right ventricular and prevent furtherdamage to its function caused by morphologic tricuspid valve insufficiency. Postoperative dimension of morphologic left atrium and cardiac function are significantly improved. The early and mid-term outcomes are satisfactory．

Citation： WEI Yu,XU Jianping. Early and Mid-term Outcomes of Morphologic Tricuspid Valve Replacement with Preservation of Entire Valvular and Subvalvular Apparatus in Corrected Transposition of Great Arteries. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2012, 19(3): 235-239. doi: Copy

1.	Cardiovasc Surg, 2004, 127 （4）：975-981.
2.	Connelly MS, Liu PP, Williams WG, et al. Congenitally corrected transposition of the great arteries in the adult：functional status and complications. J Am Coll Cardiol, 1996, 27 （5）：1238-1243.
3.	Van Praagh R, Papagiannis J, Grünenfelder J, et al. Pathologic anatomy of corrected transposition of the great arteries：medical and surgical implications. Am Heart J, 1998, 135 （5 Pt 1）：772-785.
4.	Ergenoglu MU, Yerebakan H, Ozveren O, et al. Prosthetic valve implantation with preservation of the entire valvular and subvalvular apparatus of the tricuspid valve in congenitally corrected transposition of the great arteries. Heart Surg Forum, 2011, 14 （5）：E326-327.
5.	Kuehl KS, Loffredo CA. Population-based study of l-transposition of the great arteries：possible associations with environmental factors. Birth Defects Res A Clin Mol Teratol, 2003, 67 （3）：162-167.
6.	Huhta JC, Maloney JD, Ritter DG, et al. Complete atrioventricular block in patients with atrioventricular discordance. Circulation, 1983, 67 （6）：1374-1377.
7.	Ohuchi H, Hiraumi Y, Tasato H, et al. Comparison of the right and left ventricle as a systemic ventricle during exercise in patients with congenital heart disease. Am Heart J, 1999, 137 （6）：1185-1194.
8.	Isaacson R, Titus JL, Merideth J, et al. Apparent interruption of atrial conduction pathways after surgical repair of transposition of great arteries. Am J Cardiol, 1972, 30 （5）：533-535.
9.	Ikeda U, Furuse M, Suzuki O, et al. Long-term survival in aged patients with corrected transposition of the great arteries. Chest, 1992, 101 （5）：1382-1385.
10.	Prieto LR, Hordof AJ, Secic M, et al. Progressive tricuspid valve disease in patients with congenitally corrected transposition of the great arteries. Circulation, 1998, 98 （10）：997-1005.
11.	Westerman GR, Lang P, Castaneda AR, et al. Corrected transposition and repair of associated intracardiac defects. Circulation, 1982, 66 （2 Pt 2）：I197-202.
12.	Sano T, Riesenfeld T, Karl TR, et al. Intermediate-term outcome after intracardiac repair of associated cardiac defects in patients with atrioventricular and ventriculoarterial discordance. Circulation, 1995, 92 （9 Suppl）：II272-278.
13.	Van Son JA, Danielson GK, Huhta JC, et al. Late results of systemic atrioventricular valve replacement in corrected transposition. J Thorac Cardiovasc Surg, 1995, 109 （4）：642-652.
14.	Graham TP, Jr Bernard YD, Mellen BG, et al. Long-term outcome in congenitally corrected transposition of the great arteries：a multi-institutional study. J Am Coll Cardiol, 2000, 36 （1）：255-261.
15.	Voskuil M, Hazekamp MG, Kroft LJ, et al. Postsurgical course of patients with congenitally corrected transposition of the great arteries. Am J Cardiol, 1999, 83 （4）：558-562.
16.	Graham TP Jr, Parrish MD, Boucek RJ Jr, et al. Assessment of ventricular size and function in congenitally corrected transposition of the great arteries. Am J Cardiol, 1983, 51 （2）：244-251.
17.	Hauser M, Bengel FM, Hager A, et al. Impaired myocardial blood flow and coronary flow reserve of the anatomical right systemic ventricle in patients with congenitally corrected transposition of the great arteries. Heart, 2003, 89 （10）：1231-1235.
18.	Dodge-Khatami A, Tulevski, Ii, Bennink GB, et al. Comparable systemic ventricular function in healthy adults and patients with unoperated congenitally corrected transposition using MRI dobutamine stress testing. Ann Thorac Surg, 2002, 73 （6）：1759-1764.
19.	Kharge J, Prasad MR, Ramegowda RT. An unusual case of congenitally corrected transposition of the great arteries associated with noncompaction-like remodeling of the morphological right ventricle. Echocardiography, 2011, 28 （10）：E212-214.
20.	Termignon JL, Leca F, Vouhe PR, et al. “Classic” repair of congenitally corrected transposition and ventricular septal defect. Ann Thorac Surg, 1996, 62 （1）：199-206.
21.	Shin’oka T, Kurosawa H, Imai Y, et al. Outcomes of definitive surgical repair for congenitally corrected transposition of the great arteries or double outlet right ventricle with discordant atrioventricular connections：risk analyses in 189 patients. J Thorac Cardiovasc Surg, 2007, 133 （5）：1318-1328.
22.	Ilbawi MN, Ocampo CB, Allen BS, et al. Intermediate results of the anatomic repair for congenitally corrected transposition. Ann Thorac Surg, 2002, 73 （2）：594-599.
23.	花中东, 胡盛寿, 潘湘斌, 等. 107例矫正型大动脉转位手术治疗中期结果分析. 中国循环杂志, 2009, 24 （3）：221-223.
24.	夏明钰, 王浩, 叶赞凯, 等. 经胸超声心动图评价先天性矫正型大动脉转位合并其它心内畸形的外科治疗效果. 中国超声医学杂志, 2008, 24 （11）：1036-1039.
25.	朱洪玉, 汪曾炜, 方敏华, 等. 双调转术治疗矫正型大动脉转位合并心内畸形. 中华胸心血管外科杂志, 2005, 21 （5）：260-262.
26.	Devaney EJ, Charpie JR, Ohye RG, et al. Combined arterial switch and Senning operation for congenitally corrected transposition of the great arteries：patient selection and intermediate results. J Thorac Cardiovasc Surg, 2003, 125(3）：500-507.
27.	Duncan BW, Mee RB. Management of the failing systemic right ventricle. Semin Thorac Cardiovasc Surg, 2005, 17 （2）：160-169.
28.	Mee RB. Severe right ventricular failure after Mustard or Senning operation. Two-stage repair：pulmonary artery banding and switch. J Thorac Cardiovasc Surg, 1986, 92 （3 Pt 1）：385-390.
29.	Poirier NC, Yu JH, Brizard CP, et al. Long-term results of left ventricular reconditioning and anatomic correction for systemic right ventricular dysfunction after atrial switch procedures. J Thorac.
30.	Quinn DW, Mcguirk SP, Metha C, et al. The morphologic left ventricle that requires training by means of pulmonary artery banding before the double-switch procedure for congenitally corrected transposition of the great arteries is at risk of late dysfunction. J Thorac Cardiovasc Surg, 2008, 135 （5）：1137-1144.
31.	Scherptong RW, Vliegen HW, Winter MM, et al. Tricuspid valve surgery in adults with a dysfunctional systemic right ventricle：repair or replace? Circulation, 2009, 119 （11）：1467-1472.
32.	罗国华, 胡盛寿, 孙寒松, 等. 矫正型大动脉转位形态三尖瓣置换术及中远期结果. 中国胸心血管外科临床杂志, 2009, 16 （5）：333-335.
33.	Lundstrom U, Bull C, Wyse RK, et al. The natural and "unnatural" history of congenitally corrected transposition. Am J Cardiol, 1990, 65 （18）：1222-1229.
34.	Mongeon FP, Connolly HM, Dearani JA, et al. Congenitally corrected transposition of the great arteries ventricular function at the time of systemic atrioventricular valve replacement predicts long-term ventricular function. J Am Coll Cardiol, 2011, 57 （20）：2008-2017.
35.	刘锋, 龚光甫, 熊炼 . “瓣中瓣”法二尖瓣置换术21例. 中国胸心血管外科临床杂志, 2006, 13 （2）：122-123.
36.	Straub U, Feindt P, Huwer H, et al. Postoperative assessment of chordal preservation and changes in cardiac geometry following mitral valve replacement. Eur J Cardiothorac Surg , 1996, 10 （9）：734-740.
37.	Lorenz CH, Walker ES, Graham TP Jr, et al. Right ventricular performance and mass by use of cine MRI late after atrial repair of transposition of the great arteries. Circulation, 1995, 92 （9 Suppl）：II 233-239.

1. Cardiovasc Surg, 2004, 127 （4）：975-981.
2. 　Connelly MS, Liu PP, Williams WG, et al. Congenitally corrected transposition of the great arteries in the adult：functional status and complications. J Am Coll Cardiol, 1996, 27 （5）：1238-1243.
3. 　Van Praagh R, Papagiannis J, Grünenfelder J, et al. Pathologic anatomy of corrected transposition of the great arteries：medical and surgical implications. Am Heart J, 1998, 135 （5 Pt 1）：772-785.
4. 　Ergenoglu MU, Yerebakan H, Ozveren O, et al. Prosthetic valve implantation with preservation of the entire valvular and subvalvular apparatus of the tricuspid valve in congenitally corrected transposition of the great arteries. Heart Surg Forum, 2011, 14 （5）：E326-327.
5. 　Kuehl KS, Loffredo CA. Population-based study of l-transposition of the great arteries：possible associations with environmental factors. Birth Defects Res A Clin Mol Teratol, 2003, 67 （3）：162-167.
6. 　Huhta JC, Maloney JD, Ritter DG, et al. Complete atrioventricular block in patients with atrioventricular discordance. Circulation, 1983, 67 （6）：1374-1377.
7. 　Ohuchi H, Hiraumi Y, Tasato H, et al. Comparison of the right and left ventricle as a systemic ventricle during exercise in patients with congenital heart disease. Am Heart J, 1999, 137 （6）：1185-1194.
8. 　Isaacson R, Titus JL, Merideth J, et al. Apparent interruption of atrial conduction pathways after surgical repair of transposition of great arteries. Am J Cardiol, 1972, 30 （5）：533-535.
9. 　Ikeda U, Furuse M, Suzuki O, et al. Long-term survival in aged patients with corrected transposition of the great arteries. Chest, 1992, 101 （5）：1382-1385.
10. 　Prieto LR, Hordof AJ, Secic M, et al. Progressive tricuspid valve disease in patients with congenitally corrected transposition of the great arteries. Circulation, 1998, 98 （10）：997-1005.
11. 　Westerman GR, Lang P, Castaneda AR, et al. Corrected transposition and repair of associated intracardiac defects. Circulation, 1982, 66 （2 Pt 2）：I197-202.
12. 　Sano T, Riesenfeld T, Karl TR, et al. Intermediate-term outcome after intracardiac repair of associated cardiac defects in patients with atrioventricular and ventriculoarterial discordance. Circulation, 1995, 92 （9 Suppl）：II272-278.
13. 　Van Son JA, Danielson GK, Huhta JC, et al. Late results of systemic atrioventricular valve replacement in corrected transposition. J Thorac Cardiovasc Surg, 1995, 109 （4）：642-652.
14. 　Graham TP, Jr Bernard YD, Mellen BG, et al. Long-term outcome in congenitally corrected transposition of the great arteries：a multi-institutional study. J Am Coll Cardiol, 2000, 36 （1）：255-261.
15. 　Voskuil M, Hazekamp MG, Kroft LJ, et al. Postsurgical course of patients with congenitally corrected transposition of the great arteries. Am J Cardiol, 1999, 83 （4）：558-562.
16. 　Graham TP Jr, Parrish MD, Boucek RJ Jr, et al. Assessment of ventricular size and function in congenitally corrected transposition of the great arteries. Am J Cardiol, 1983, 51 （2）：244-251.
17. 　Hauser M, Bengel FM, Hager A, et al. Impaired myocardial blood flow and coronary flow reserve of the anatomical right systemic ventricle in patients with congenitally corrected transposition of the great arteries. Heart, 2003, 89 （10）：1231-1235.
18. 　Dodge-Khatami A, Tulevski, Ii, Bennink GB, et al. Comparable systemic ventricular function in healthy adults and patients with unoperated congenitally corrected transposition using MRI dobutamine stress testing. Ann Thorac Surg, 2002, 73 （6）：1759-1764.
19. 　Kharge J, Prasad MR, Ramegowda RT. An unusual case of congenitally corrected transposition of the great arteries associated with noncompaction-like remodeling of the morphological right ventricle. Echocardiography, 2011, 28 （10）：E212-214.
20. 　Termignon JL, Leca F, Vouhe PR, et al. “Classic” repair of congenitally corrected transposition and ventricular septal defect. Ann Thorac Surg, 1996, 62 （1）：199-206.
21. 　Shin’oka T, Kurosawa H, Imai Y, et al. Outcomes of definitive surgical repair for congenitally corrected transposition of the great arteries or double outlet right ventricle with discordant atrioventricular connections：risk analyses in 189 patients. J Thorac Cardiovasc Surg, 2007, 133 （5）：1318-1328.
22. 　Ilbawi MN, Ocampo CB, Allen BS, et al. Intermediate results of the anatomic repair for congenitally corrected transposition. Ann Thorac Surg, 2002, 73 （2）：594-599.
23. 　花中东, 胡盛寿, 潘湘斌, 等. 107例矫正型大动脉转位手术治疗中期结果分析. 中国循环杂志, 2009, 24 （3）：221-223.
24. 　夏明钰, 王浩, 叶赞凯, 等. 经胸超声心动图评价先天性矫正型大动脉转位合并其它心内畸形的外科治疗效果. 中国超声医学杂志, 2008, 24 （11）：1036-1039.
25. 　朱洪玉, 汪曾炜, 方敏华, 等. 双调转术治疗矫正型大动脉转位合并心内畸形. 中华胸心血管外科杂志, 2005, 21 （5）：260-262.
26. 　Devaney EJ, Charpie JR, Ohye RG, et al. Combined arterial switch and Senning operation for congenitally corrected transposition of the great arteries：patient selection and intermediate results. J Thorac Cardiovasc Surg, 2003, 125(3）：500-507.
27. 　Duncan BW, Mee RB. Management of the failing systemic right ventricle. Semin Thorac Cardiovasc Surg, 2005, 17 （2）：160-169.
28. 　Mee RB. Severe right ventricular failure after Mustard or Senning operation. Two-stage repair：pulmonary artery banding and switch. J Thorac Cardiovasc Surg, 1986, 92 （3 Pt 1）：385-390.
29. 　Poirier NC, Yu JH, Brizard CP, et al. Long-term results of left ventricular reconditioning and anatomic correction for systemic right ventricular dysfunction after atrial switch procedures. J Thorac.
30. 　Quinn DW, Mcguirk SP, Metha C, et al. The morphologic left ventricle that requires training by means of pulmonary artery banding before the double-switch procedure for congenitally corrected transposition of the great arteries is at risk of late dysfunction. J Thorac Cardiovasc Surg, 2008, 135 （5）：1137-1144.
31. 　Scherptong RW, Vliegen HW, Winter MM, et al. Tricuspid valve surgery in adults with a dysfunctional systemic right ventricle：repair or replace? Circulation, 2009, 119 （11）：1467-1472.
32. 　罗国华, 胡盛寿, 孙寒松, 等. 矫正型大动脉转位形态三尖瓣置换术及中远期结果. 中国胸心血管外科临床杂志, 2009, 16 （5）：333-335.
33. 　Lundstrom U, Bull C, Wyse RK, et al. The natural and "unnatural" history of congenitally corrected transposition. Am J Cardiol, 1990, 65 （18）：1222-1229.
34. 　Mongeon FP, Connolly HM, Dearani JA, et al. Congenitally corrected transposition of the great arteries ventricular function at the time of systemic atrioventricular valve replacement predicts long-term ventricular function. J Am Coll Cardiol, 2011, 57 （20）：2008-2017.
35. 　刘锋, 龚光甫, 熊炼 . “瓣中瓣”法二尖瓣置换术21例. 中国胸心血管外科临床杂志, 2006, 13 （2）：122-123.
36. 　Straub U, Feindt P, Huwer H, et al. Postoperative assessment of chordal preservation and changes in cardiac geometry following mitral valve replacement. Eur J Cardiothorac Surg , 1996, 10 （9）：734-740.
37. 　Lorenz CH, Walker ES, Graham TP Jr, et al. Right ventricular performance and mass by use of cine MRI late after atrial repair of transposition of the great arteries. Circulation, 1995, 92 （9 Suppl）：II 233-239.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Early and Mid-term Outcomes of Morphologic Tricuspid Valve Replacement with Preservation of Entire Valvular and Subvalvular Apparatus in Corrected Transposition of Great Arteries

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