Tricuspid atresia: Analysis of coronary artery distribution and ventricular morphology

Abstract

There is still disagreement concerning the precise nature of the anterior ventricular chamber in 'tricuspid atresia'. Some argue that it is a right ventricle, while our own previous studies have suggested it is comparable to the outlet chamber seen in classical 'single ventricle'. We have compared the morphology of the anterior ventricular chambers in 48 examples of tricuspid atresia (absent right atrioventricular connection), 24 hearts with double inlet to the left ventricular chamber, and 15 hearts with pulmonary atresia and intact ventricular septum. Since there is further disagreement concerning the nature of the coronary artery which delimits the posterior extent of the ventricular septum in these heart, we analysed the position of this vessel relative to external reference points on the atrioventricular junction. No significant difference was found with respect to the morphometry of hearts with tricuspid atresia (absent right atrioventricular connection) and those with double inlet. In both groups, however, significant differences were shown between hearts with ventriculoarterial concordance and discordance. Coronary artery disposition was the same in both groups and different from that found in hearts with pulmonary atresia and intact septum. We conclude that the ventricular morphology is comparable in hearts with tricuspid atresia (absent right atrioventricular connection) and those with doublet inlet to a left ventricular chamber. The lesions are distinguishable by their atrioventricular connection which is nevertheless univentricular in both.