Morphology of Tricuspid Valve in Pulmonary Atresia with Intact Ventricular Septum

Abstract

Pulmonary atresia with intact ventricular septum (PAIVS) is a rare congenital cardiac anomaly that has been classified into two types: one is a more frequent type having dysplasia of tricuspid valve (TV) with a small annulus, underdeveloped right ventricle (RV) with a hypoplastic cavity and a hypertrophic wall; the other type has severe dysplasia of TV and dilatation of RV, right atrium (RA), and right atrioventricular junction with thinning of the RV wall. We performed a morphologic study on 11 autopsied hearts with PAIVS, giving particular emphasis to the variation of morphology of the TV. We could classify these hearts into 3 groups according to the degree of right ventricular development. In the first group of 7 cases (type I), the RVs were underdeveloped. Thick leaflets, restricted valve apparatus with short chordae, and small annuli were characteristics of the TV. In the second group of 3 cases (type II), the RVs showed marked enlargement of the cavity and thinning of the wall. The TV showed redundant, dysplastic, sail-like anterior leaflets, and the downward displacement of septal leaflet and/or posterior leaflet, which are the findings frequently observed in Ebstein's malformation. The RVs were dilated and with partially unguarded tricuspid orifice. The septal leaflet of the TV was dysplastic and, in two cases, the septal leaflet showed chordal structure at the upper surface facing the RA, which is a peculiar finding that has not been described in the literature. The remaining case was a heart with a moderately developed RV (type III). The TV showed mildly dysplastic appearance and we classify this as a separate type, because we could expect the best surgical results in this type. This type had optimal size of RV and the mildest degree of dysplasia of TV. In PAIVS, the morphology of TV correlates well with the type of the right ventricular development.

Long-term results of catheter-based treatment of pulmonary atresia and intact ventricular septum

“…PAIVS is a rare complex congenital heart disease with significant morphological heterogeneity, which invokes a wide variety of treatment strategies 1 2 3. Biventricular repair could be achieved in the presence of adequate right heart structures, whereas univentricular repair or heart transplantation are the options for patients with hypoplastic monopartite right ventricle or with right ventricle-dependent coronary circulation 4 6 7 12 13.…”

“…Pulmonary atresia with intact ventricular septum (PAIVS) is a complex congenital heart disease with remarkable morphological variability, affecting the right ventricle, tricuspid and pulmonary valves and coronary arteries 1 2. Management strategy for affected infants mainly depends on the severity of cardiac lesions.…”

Pulmonary atresia with intact ventricular septum and hypoplastic right ventricle in an Arabian foal

“…The lack of egress of blood from the RV has been offered as an explanation for morphologic changes of the tricuspid valve and tricuspid valve apparatus [9]. The spectrum of changes ranges from severe stenosis to marked regurgitation with dysplasia or hypoplasia of chordae tendinae and papillary muscles [23].…”

Catheter-based Therapy for Small Preterm Infants with Pulmonary Atresia/Intact Ventricular Septum

“…Catheter‐based therapy is the preferred treatment for patients with PA/IVS without RV‐dependent coronaries allowing a one‐and‐a‐half or two‐ventricle circulation 1,2,4 . Important predictors of success are RV morphology with a tripartite right ventricle 9 and adequate tricuspid valve/annular morphology 10 . Cheatham suggests a tricuspid annulus of ≥11 mm, a membranous atretic pulmonary valve with an annulus ≥7 mm, and a well‐formed infundibulum as attributes that portend a favorable two‐ventricle outcome 3 .…”