Parachute Tricuspid Valve: A Case Treated by Open Heart Surgery

Abstract

Parachute valve is the malformation of an atrioventricular valve in which the tension apparatus springs from a single papillary muscle or group of muscles. Parachute tricuspid valve is a rare anomaly with no surgically repaired case to date. We describe a case of parachute deformity of the tricuspid valve leading to hemodynamically significant severe tricuspid stenosis. The present case was successfully repaired surgically along with atrial septal defect (ASD) and ventricular septal defect (VSD) closure.

Parachute tricuspid valve: a systematic review

“… 2012 Demirkol et al [ 8 ] 24 M Bifid single TTE, 3D-TTE, TEE, 3D-TEE, CTA ASD RV Doming shaped, TR (trivial) Elongated 4/3/? Surgical closure of ASD Recovered 1997 Godart et al [ 9 ] Neonate (she grew up to 2 years) F Single anterior papillary Echocardiography C-TGA, VSDs, small RV (TV annulus 9 mm), hypoplastic aortic arch, coarctation, PDA, s/p coarctation repair + arch plasty + banding, s/p debanding, PAH TV obstruction (annular ring), TS ?/?/18 Annular ring resection + TVR Died of postoperative septic shock 2016 Gupta et al [ 10 ] 0.625 M TTE ASD, VSD (perimembrane) TV stenosis 14/7/? VSD closure + chord transition (to support the free edge of the neoseptal leaflet) + ASD closure 4 Complicated: Escherichia coli pneumonia, recovered 2013 Kurtul et al [ 11 ] 33 M TTE Parachute MV, VSD (perimembrane), PAH (44 mmHg), anomalous origin of the circumflex artery from the right sinus of Valsalva RV, LA Normal function Transcatheter closure of VSD …”

“…In the remaining 13 patients, 3 (23.1%) were asymptomatic and 10 (76.9%) were symptomatic ( χ 2 = 7.5, P = 0.017). The major symptoms of the 10 symptomatic patients were palpitations [ 5 , 7 ], heart failure [ 9 , 10 ], dyspnea [ 4 ] and peripheral edema [ 6 ].…”

“…This case was excluded from the statistical analysis of tricuspid valve function. In the remaining 10 patients, 6 (60%) patients had tricuspid regurgitation (it was trivial ( n = 2, 33.3%) [ 7 , 8 ], mild ( n = 1, 16.7%) [ 14 ], mild-to-moderate ( n = 1, 16.7%) [ 5 ] and moderate-to-severe [ 5 ] ( n = 1, 16.7%)), 3 (30%) had tricuspid stenosis [ 6 , 9 , 10 ] and 1 (10%) had a normally functioning tricuspid valve [ 11 ]. The systolic tricuspid pressure gradient was 8.3 ± 4.2 mmHg and the mean tricuspid pressure gradient was 4.3 ± 1.9 mmHg [ 7 , 8 , 10 , 15 ].…”

“…Of the 14 patients, 12 (85.7%) patients had one or more associated congenital heart defects, including atrial septal defect [ 5 , 8 , 10 , 13 , 15 ], ventricular septal defect [ 10 , 13 , 16 ], cor triatriatum [ 12 ], corrected transposition of the great arteries [ 9 , 14 ], tetralogy of Fallot and pulmonary atresia [ 6 ] and parachute mitral valve and anomalous origin of the circumflex branch from the right sinus of Valsalva [ 11 ]; and 2 patients had an isolated PTV (14.3%). PTVs associated with other cardiac malformations were significantly more than isolated PTVs ( χ 2 = 14.3, P < 0.001).…”

“…The treatments were not described for 4 patients. Of the remaining 10 patients, a surgical/interventional treatment was required in 6 (60%) patients: tricuspid valve operation in 2 (33.3%) patients (annular ring resection plus tricuspid valve replacement [ 9 ], and chord transition [ 10 ]), and surgical/interventional repair of other associated intracardiac anomalies in 5 (83.3%) patients (the patient receiving chord transition had simultaneous atrial and ventricular septal defect closures [ 10 ]) including device closure of atrial septal defect [ 5 , 11 ], surgical closure of atrial septal defect [ 8 ], chord transition (to support the free edge of the neoseptal leaflet) plus atrial and ventricular septal defect closures [ 10 ] and straddling mitral valve repair plus ventricular septal defect closure [ 4 ]. In addition, 4 (40%) patients were on a follow-up only due to mild clinical symptoms.…”