The Degree of Left Ventricular Hypoplasia Is Associated with Tricuspid Regurgitation Severity in Infants with Hypoplastic Left Heart Syndrome

A pilot investigation of the tricuspid valve annulus in newborns with hypoplastic left heart syndrome

“…8,9 Patient characteristics with the presence and recurrence of TR have been documented, including early intervention (eg, younger, lower body weight) and abnormal valve architectures (eg, leaflet tethering). [6][7][8][10][11][12][13][14][15][16] These complications may be due to the increased afterload on the TV during the reconstructive palliations, subsequently resulting in valvular tissue remodeling to maintain tissue homeostasis. [17][18][19] While these advancements facilitate a deeper understanding of the geometric abnormalities related to the presence of TR in patients with HLHS, there are currently no biomechanics-focused studies of the TV structures.…”

High-Risk Anatomic Subsets in Hypoplastic Left Heart Syndrome

“…33 Others have suggested that right ventricle (RV) dilation may lead to tricuspid insufficiency and, as mentioned, that small left ventricular cavity size may be associated with worse insufficiency. 32 Some therefore suggest that with severe left ventricle (LV) hypoplasia, reducing the volume load on the RV with a Sano RV to PA conduit during the Norwood operation, earlier cavopulmonary connection, and more aggressive management of collaterals could limit the progression of the TR. 32…”

“…32 Some therefore suggest that with severe left ventricle (LV) hypoplasia, reducing the volume load on the RV with a Sano RV to PA conduit during the Norwood operation, earlier cavopulmonary connection, and more aggressive management of collaterals could limit the progression of the TR. 32…”

“…Although the mechanism is unknown, patients with more severe left ventricular hypoplasia tend to have worse progression of tricuspid regurgitation. 32 In addition, repair strategies in patients with a dilated systemic tricuspid valve can be more challenging.…”

“…33 Others have suggested that right ventricle (RV) dilation may lead to tricuspid insufficiency and, as mentioned, that small left ventricular cavity size may be associated with worse insufficiency. 32 Some therefore suggest that with severe left ventricle (LV) hypoplasia, reducing the volume load on the RV with a Sano RV to PA conduit during the Norwood operation, earlier cavopulmonary connection, and more aggressive management of collaterals could limit the progression of the TR. 32 However, it is unknown if the mortality implications of valve insufficiency would persist after repair, as implied by studies that indicate that greater than mild AV valve regurgitation at the time of diagnosis remains a predictor of mortality in single RV patients after all 3 stages of palliation.…”