The morphologically tricuspid valve in hypoplastic left heart syndrome

OBJECTIVE: Competence of the tricuspid valve is crucial for survival of children with hypoplastic left heart syndrome. We studied the morphology and topology of the valvar and subvalvar structures, trying to identify abnormalities which could impair valvar function. METHODS: A total of 82 specimens with hypoplastic left heart syndrome were examined pathologically. Measurements of valvar dimensions were taken, significant dysplasia of the valvar leaflets was noted and the muscular and tendinous supporting structures determined. The findings were correlated to the subgroups of hypoplastic left heart syndrome. RESULTS: Of the hearts, 10 (12%) showed a bileaflet right atrioventricular valve, 27 (33%) a moderately and 2 (2%) a severely dysplastic tricuspid valve. The majority of the abnormalities was found in hearts with a patent mitral valve. In 79% of the hearts with mitral atresia, the septal surface was concave instead of convex to the right ventricular lumen and the direct tendinous attachments of the septal leaflet replaced by a multitude of freestanding papillary muscles. The number of direct septal attachments was significantly higher in hearts with a patent mitral valve. CONCLUSIONS: The tricuspid valve in hypoplastic left heart syndrome can differ from the valve seen in normal patients. The subvalvar apparatus is different in hearts with mitral atresia, whereas dysplasia of the leaflets occurs more often together with mitral stenosis. These features should be considered in reconstructive operations as well as during diagnostic procedures.