Skip to main content Accessibility help

Biventricular repair of lesions with straddling tricuspid valves using techniques of cordal translocation and realignment

  • V. Mohan Reddy (a1), John R. Liddicoat (a1), Doff B. McElhinney (a1), Michael M. Brook (a2), Jacques A.M. van Son (a1) and Frank L. Hanley (a1)...


Surgical Management of straddling tricuspid valve and associated defects is a complex problem. Between August 1992 and August 1995, 5 patients with major straddling of the tricuspid valve underwent a complete or partial biventricular repair. All patients had either an inlet ventricular septal defect (n=4) or a ventricular septal defect with an inlet component (n=1), Co-existing cardiac lesions included hypoplasia of the right ventricle (n=3), discordant ventriculoarterial connections (n=1), tetralogy of Fallot (n=1), and multiple muscular vetricular septal defects (n=2). At the time of presentation to our institution, two of these patients had previously been palliated in preparation for a Fontan procedure, having undergone construction of a bidirectional superior cavopulmonary shunt. One patient was referred specifically for a Fontan procedure. The tricuspid valve was repaired by transecting all of the straddling cords and reattaching them in the right ventricle or onto the right side of the patch used to close the ventricular septal defect. Associated procedures included closure of the septum in all patients, an arterial switch procedure in one, repair of tetralogy of Fallot in one, and construction of a bidirectional superior cavopulmonary shunt in one. There has been no early or late mortality. Complete heart block requiring insertion of a pacemaker occurred after surgery in three patients. At a median follow-up of 32 months, functional integrity of the tricuspid valve is well maintained, with only one patient having moderate tricuspid regurgitation. None of the patients are receiving any cardiac medication.


Corresponding author

V. Mohan Reddy, M.D., Division of Cardiothoracic Surgery, University of California, San Francisco, 505 Parnassus Avenue, M593, San Francisco, CA 94143-0118. Tel: 415-476-3501; Fax: 415-476-9678


Hide All
1.Milo, S, Ho, SY, Macartney, FJ, Wilkinson, JL, Becker, AE, Wenink, ACG, Gittenberger-deGroot, AC, Anderson, RH. Straddling and overriding atrioventicular valves: Morphology and classification. Am J Cardiol 1979; 44: 11221134.
2.Kirklin, JW, Barratt-Boyes, BG. Cardiac Surgery. Churchill Livingston, New York, 1993, pp 811817.
3.Wenink, ACG, Gittenberger-de Groot, AC. Straddling mitral and tricuspid valves: Morphologic differences and develop mental backgrounds. Am J Cardiol 1982; 49: 19591971. Vivie, R, Van Praagh, S, Bein, G, Eigster, G, Vogt, J, Van Praagh, R. Transposition of the great arteries with straddling tricuspid valve: Report of two rare cases with acquired subaortic stenosis after main pulmonary artery banding. J Thorac cardiovasc Surg 1989; 98: 205213.
5.Kirklin, JW, Anderson, RH, Pacifico, AD, Kirklin, JK, Bargeron, LM. Surgery for hearts with straddling and overriding atrioventricular valves. In: Baue, AE, Geha, AS, Hammond, GL, Laks, H, Naunheim, KS (eds). Glenn's Thoracic and Cardiovascular Surgery. Appleton & Lange, Norwalk, 1991, pp 10691078.
6.Danielson, GK, Tabry, IF, Fulton, RE, Hagler, DJ, Ritter, DG. Successful repair of straddlingt atrioventricular valve by technique used for septation of univentricular heart. Ann Thorac Surg 1979; 28: 554560.
7.Pacifico, AD, Soto, B, Bargeron, LM. Surgical treatmemt of straddling tricuspid valves. Circulation. 1979; 60: 655664.
8.Tabry, IF, McGoon, DC, Danielson, GK, Wallace, RB, Tajik, AJ, Seward, JB. Surgical management of straddling atrioventricular valve. J Thorac Cardiovasc Surg 1979; 77: 191201.
9.Serraf, A, Nakamura, T, Lacour-Gayet, F, Piot, D, Bruniaux, J, Touchot, A, Sousa-Uva, M, Houyel, L, Planché, C. Surgical approaches for double-outlet right ventricle or transposition of the great arteries associated with straddling atrioventircular valves. J Thorac Cardiovasc Surg 1996; 111: 527535.
10.Wilcox, BR, Anderson, RH. Surgical Anatomy of the Heart, 2nd Edition. Gower Medical Publishing, London, 1992.
11.Hoyer, MH, Zuberbuhler, JR, Anderson, RH, del Nido, P. Morphology of ventricular septal defects in complete trasposition. J Thorac Cardiovasc Surg 1992; 104: 12031211.
12.Driscoll, DJ, Offord, KP, Feldt, RH, Schaff, HV, Puga, FJ, Danielson, GK. Five-to fifteen-year follow-up after Fontan operation. Circulation 1992; 85: 469496.
13.Fontan, F, Kirklin, JW, Fernandez, G, Costa, F, Naftel, DC, Tritto, F, Blackstone, EH. Outcome after a “perfect” Fontan operation. Circulation 1990; 81: 15201536.


Related content

Powered by UNSILO

Biventricular repair of lesions with straddling tricuspid valves using techniques of cordal translocation and realignment

  • V. Mohan Reddy (a1), John R. Liddicoat (a1), Doff B. McElhinney (a1), Michael M. Brook (a2), Jacques A.M. van Son (a1) and Frank L. Hanley (a1)...


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.