De vega tricuspid annuloplasty for systemic tricuspid regurgitation in children with univentricular physiology

Background and aim of the study: Significant tricus-pid valve regurgitation (TR) is problematic in chil-dren with univentricular physiology and a systemic tricuspid valve occasionally requiring tricuspid (sys-temic atrioventricular) valve replacement. Since 1998, the De Vega tricuspid annuloplasty technique has been applied for TR in these children. Methods: Twelve children (median age 2.2 years; range: 6 months to 17 years) with moderate or severe systemic TR underwent a De Vega tricuspid annulo-plasty during a bidirectional Glenn anastomosis (n = 3), Fontan procedure (n = 8) or aortic valve replace-ment late after a Fontan procedure (n = 1). Nine patients (75%) had prior Norwood palliation for hypoplastic left heart syndrome. Four patients had simultaneous repair of an abnormal tricuspid valve in addition to the De Vega procedure. Results: There were no deaths during a mean follow up of 2.0 ± 1.4 years (range: 6 months to 5.1 years). One child required pacemaker implantation early after operation, and one child with a Glenn anasto-mosis underwent cardiac transplantation 21 months postoperatively. In the remaining 11 patients, the most recent echocardiogram showed mild or no TR in eight children, mild-to-moderate TR in one child, and moderate TR in two children. No child had symptomatic TR (including the two with moderate TR), significant tricuspid stenosis, or late pacemaker implantation. Conclusion: The De Vega tricuspid annuloplasty safely provides excellent relief of systemic TR in children with univentricular physiology, with a majority of patients (73%) having mild or less resid-ual TR at follow up examination. This simple tech-nique is preferred to tricuspid (systemic) valve replacement in these children.