Tricuspid atresia

Definition

Tricuspid atresia is a type of congenital heart disease in which blood is unable to flow from the right atrium to the right ventricle because the tricuspid valve is missing or abnormally developed.

Causes, incidence, and risk factors

Tricuspid atresia is an uncommon form of congenital heart disease.

In a normal body, unoxygenated blood flows into the right atrium, then through the tricuspid valve to the right ventricle and on to the lungs. If the tricuspid valve is absent or malformed, blood cannot pass from the right atrium to the right ventricle and therefore cannot enter the lungs to be oxygenated.

For unoxygenated blood to reach the lungs, it must flow from the right atrium into the left atrium through a hole called the foramen ovale, which is a passageway in the fetal heart that normally closes shortly after birth. From the left atrium, blood then flows to the left ventricle and then either to the right ventricle, through a hole called a ventricular septal defect (VSD), or to the aorta.

If blood flows from the left ventricle to the aorta, another fetal passageway that normally closes, called the ductus arteriosus, allows some of the blood to flow into the pulmonary artery. This supplies the lungs with less than optimal blood flow and puts a strain on the left ventricle, which must now pump the blood supply for both the body and the lungs.

Infants with tricuspid atresia generally are cyanotic (bluish discoloration of skin) due to the mixing of deoxygenated blood with the normally oxygenated blood in the aorta. They become short of breath (dyspneic) easily.

Various surgical approaches have been developed and vary depending on the age of the individual at the time the surgery is done.

Symptoms

• cyanosis (bluish discoloration of the skin)
• easily fatigued
• shortness of breath (dyspnea)
• clubbing of fingers or toes

Signs and tests

This condition may be discovered during routine prenatal ultrasound imaging or upon examination shortly after birth. Cyanosis may be present from birth. A heart murmur is generally present at birth and may increase in loudness over several months.

Tests may include the following:

• ECG -- may show left ventricular hypertrophy
• echocardiogram -- will show absent tricuspid valve and small right ventricle for definitive diagnosis
• chest X-ray -- may show heart enlargement
• cardiac catheterization (rarely performed)

Treatment

Surgery is necessary to repair the abnormal circulation created by tricuspid atresia. Approaches vary depending on the severity of the defect, but usually a series of operations is required.

Surgical treatment initially involves a shunt (or bypass) from the aorta to the pulmonary arteries. Definitive treatment is with a Fontan operation, where the systemic venous return is connected to the pulmonary arterial tree.

Expectations (prognosis)

Improvement can be expected with most surgical procedures. Unexpected death may occur with heart arrhythmias.

Complications

• sudden death

Calling your health care provider

Call your baby's health care provider if problems or new symptoms develop.

Prevention

There is no known way to prevent tricuspid atresia.

Illustrations

Heart, section through the middle

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Tri Atresia