Background: Right ventricle decompression is attempted in some infants with pulmonary valve atresia with an intact ventricular septum with the aim of achieving a biventricular circulation. There is a wide range of morphological diversity in this condition which dictates long term outcomes. We aimed to identify baseline echocardiographic variables, which could help to predict whether a patient would achieve a biventricular or other circulation following right ventricular decompression.
Methods: A single-centre retrospective cohort study was conducted on patients with pulmonary valve atresia with an intact ventricular septum who underwent right ventricle decompression via either cardiac catheterization or surgery from January 2000 to January 2020, comparing baseline echocardiographic parameters between patients who achieved biventricular repair against those who established a non-biventricular circulation. Univariate analysis and a receiver-operator-characteristic curve were utilised to identify baseline echocardiographic parameters predictive of biventricular repair.
Results: The median baseline tricuspid valve: mitral valve ratio was significantly greater in patients who achieved biventricular repair in comparison to those who established non-biventricular repair (1.00 (IQR 0.85–1.13) vs 0.79 (IQR 0.66–0.87), p=0.013). A baseline tricuspid valve: mitral valve ratio >0.82 was identified as a good predictor. Other predictors of successful biventricular repair included a baseline tripartite right ventricle (p=0.038), and greater baseline severity of tricuspid regurgitation (p=0.006).
Conclusion: In patients with pulmonary atresia with intact ventricular septum, a baseline tricuspid valve: mitral valve ratio >0.82, presence of a tripartite right ventricle morphology and having moderate-to-severe tricuspid regurgitation are predictors to achieve biventricular circulation after right ventricle decompression.
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