Tricuspid atresia

Alternative Names

Treatment

Once the diagnosis is made, the baby will be admitted to the neonatal intensive care unit (NICU). A breathing machine (ventilator) may be needed to help the baby breathe. A medicine called prostaglandin E1 is used to maintain circulation of blood to the body.

The condition always requires surgery. If the heart is unable to pump enough blood out to the lungs and rest of the body, the first surgery usually occurs within the first few days of life. In this procedure, an artificial shunt is inserted to maintain blood flow to the lungs.

Afterwards, the baby usually goes home. The child will need to take one or more daily medicines and be closely followed by a pediatric cardiologist, who will determine when the second stage of surgery should be done.

Stage II of the operation is called the Glenn shunt or Hemifontan procedure. This procedure connects half of the veins carrying blue blood from the body directly to blood vessels to the lungs that get oxygen. The surgery is usually done when the child is between 4 - 6 months of age.

During stage I and II, the child may still appear somewhat blue (cyanotic).

Stage III, the final step, is called the Fontan procedure. The remainder of the veins carrying blue blood from the body is connected directly to blood vessels leading to the lungs, and the right ventricle now serves as the only pumping chamber for the heart. This surgery is usually performed between the ages of 18 months and 3 years of age. After this final step, the baby is no longer blue (cyanotic).

Some patients may need more surgeries in their 20s or 30s if they develop hard to control arrhythmias or other complications of the Fontan procedure.

In some hospitals, heart transplantation is considered to be a better alternative to the 3-step surgery process, but there are few donated hearts available for small infants.

Outlook (Prognosis)

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

Possible Complications

• Irregular, fast heart rhythms (arrhythmias)
• Chronic diarrhea (from a disease called protein loosing enteropathy)
• Heart failure
• Fluid in the abdomen (ascites) and in the lungs (pleural effusion)
• Blockage of the artificial shunt
• Strokes and other neurological complications
• Sudden death

When to Contact a Medical Professional

If your infant has new changes in breathing patterns, eats less (decreased feeing), or has skin or mucous membranes that are turning blue (cyanotic), contact your health care provider immediately.

References

Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 8th ed. St. Louis, Mo; WB Saunders; 2007.