The Journal of Thoracic and Cardiovascular Surgery, Vol 89, 597-603, Copyright © 1985 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Tricuspid atresia. Morphology of the outlet chamber with special emphasis on surgical implications
J Ottenkamp, AC Wenink, JM Quaegebeur, J Rohmer, AC Gittenberger-de Groot, AG Brom and F Fontan
An anatomic study of 28 heart specimens with tricuspid atresia showed 15
hearts with ventriculoarterial concordance and a right-sided anterior
outlet chamber. Of these 15 hearts, 12 showed evidence of restricted
pulmonary blood flow. In eight of these 12 specimens, an anterior deviation
of the outlet septum, relative to the primary septum, was present. This
deviation caused a narrowing inside the outlet chamber and functioned as
infundibular pulmonary stenosis. The outlet chambers of the 15 hearts with
ventriculoarterial concordance were compared with those of 13 hearts with
tricuspid atresia and ventriculoarterial discordance and also a right-sided
anterior outlet chamber. In the latter group of 13 hearts, five showed
evidence of restricted pulmonary blood flow, at least partially caused by
posterior deviation of the outlet septum relative to the primary septum. A
clear difference in outlet chamber morphology was found without exception
between specimens with and without ventriculoarterial concordance. Clinical
data in three long-term survivors of the Fontan procedure demonstrate that
the special morphology of the outlet chamber can pose surgical problems.
Especially in patients with ventriculoarterial concordance, when the outlet
chamber is incorporated into the pulmonary circuit, the surgeon must give
special attention to the specific morphology to prevent undesirable
sequelae.
