Tricuspid Valve Replacement in Children

Between 1974 and January, 1986, 11 children underwent 13 tricuspid valve replacements at the Hospital for Sick Children in Toronto. Age at operation ranged from 24 hours to 14.5 years (mean, 6.9 years). Morphology of the tricuspid valves included Ebstein's anomaly (6 patients), congenital tricuspid regurgitation (3), tricuspid regurgitation and univentricular heart (1), and previous tricuspid valve excision for acute endocarditis (1). There were 4 early deaths: the 3 youngest infants in the series (age 1 day to 16 days) and another child who underwent emergency valve replacement died. On follow-up to 13 years after valve replacement, there were 2 late deaths and two reoperations. Both reoperations were for calcified degenerative tissue prostheses 6.5 and 9 years following implantation. The estimated 5-year survival based on a collected review of data from the literature is 68 ± 9% for children with prosthetic tricuspid valves. Although tissue valve durability is better in the tricuspid position than on the systemic side of the circulation, calcification does result in late dysfunction. Tricuspid valve repair should always be carried out when possible, especially in the infant group. Elective prosthetic valve replacement in older children can be performed with reasonable operative risk and reasonable late results.