CHSS Main Site  |  Past & Future Meetings
Congenital Heart Surgeons' Society

Back to 2022 Abstracts


Bicuspidization Of A Tricuspid Truncal Valve
Stephanie N. Nguyen, MD, Ismail A. Bouhout, MD, PhD, David M. Kalfa, MD, PhD.
New York Presbyterian - Columbia University Irving Medical Center, New York, NY, USA.

Background: Truncal valve insufficiency (TVI) is an important risk factor in truncus arteriosus and often requires surgical intervention. We present a tricuspid truncal valve repair using a bicuspidization technique.
Case Summary: A 10-month-old girl (7.2kg) with DiGeorge syndrome and prenatally diagnosed truncus arteriosus (type I) underwent PA banding followed by complete repair as a neonate; however, the truncal valve was too dysplastic to be concomitantly addressed. She presented with severe TVI and biventricular dysfunction from coronary steal. Echocardiography demonstrated significant LV dilation and a tricuspid truncal valve with poor leaflet coaptation and severe insufficiency. Valve inspection revealed annular dilation, high take-off coronaries, tricuspid truncal valve with posterior left, posterior right, and anterior leaflet with a raphe. Bicuspidization was undertaken using interrupted sutures between the two posterior leaflets, ensuring equal free-edge length of the two neo-cusps. Takedown of the posterior commissure and anterior raphe were performed to increase mobility of the respective cusps. The anterior leaflet was resuspended by commissuroplasty, followed by free margin plication to address mild prolapse. Finally, a subcommissural annuloplasty was performed for annular reduction. Inspection of the neo-bicuspid truncal valve revealed good effective height and symmetric free margins with 180 commissural orientation. Echocardiography showed trivial TVI. The patient had an uneventful recovery and continues to do well with trivial mixed insufficiency/stenosis and normal LV function on latest follow-up.
Conclusion: Bicuspidization of a truncal valve using established surgical principles of aortic valve repair is feasible and reproducible. Repair durability remains unknown and long-term follow-up is warranted.


Back to 2022 Abstracts