AV Valve Repair in a 3 kg Infant With Tricuspid Atresia
The patient was diagnosed prenatally with tricuspid atresia. The
patient was born full term with a birth weight of 2.8 kg. Diagnosis was
confirmed as tricuspid atresia with transposition of the great arteries.
Atrial septal defect and bulboventricular foramen were unrestrictive
and the BVF was larger in dimension than the aortic valve. The patient
underwent PA banding as a neonate. Distal pulmonary artery pressures
were brought down to about one third systemic with saturations around
80%. The band gradient persisted at around 50 mm Hg. The patient did
well immediately after surgery but over the next 3-4 weeks developed
worsening mitral regurgitation due to annular dilatation. Despite
maximal medical therapy, the patient developed low cardiac output, renal
failure requiring peritoneal dialysis, and needed mechanical
ventilation. The authors recommended surgical mitral valve repair. There
was no cleft seen in the anterior leaflet of the mitral valve. They
performed an annuloplasty and this significantly improved mitral
regurgitation.
