Tricuspid atresia pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Sara Zand, M.D.[2] Keri Shafer, M.D. [3] Priyamvada Singh, MBBS [4]; Assistant Editor-In-Chief: Kristin Feeney, B.S. [5]

Historical perspective

• Tricuspid atresia was first discovered by Friedrich Ludwig kreysig in 1817, a German physician who found the obstruction between the right atrium and right ventricle in the autopsy of cyanotic infants.

• The classic term of tricuspid atresia was used firstly by schuberg in 1861.
  

Pathophysiology

Normal Human Heart

Caption:Anterior (frontal) view of the opened heart. White arrows indicate normal blood flow. (Tricuspid valve labeled at bottom left.)

Tricuspid Atresia

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• Tricuspid atresia occurs during prenatal development.
• In tricuspid atresia, there is no continuity between the right atrium and right ventricle.

• Inferior vena cava and superior vena cava collect venous nonoxygenated blood into the right atrium.

• Through atrial septal defect (ASD)blood reaches into the left atrium, then left ventricle andaorta.
• This blood is a mixture of saturated and unsaturated O2.

• If there is a ventricular septal defect (VSD), this mixed blood in the left ventricle flows into the right ventricle, then via pulmonary artery reaches pulmonary bed and becomes oxygenated, then returns back into the left atrium viapulmonary veins.

• In diminished pulmonary blood flow whether the flow is dependent on patent ductus arteriosus (PDA), the mixed-blood in aorta flows from this passage intopulmonary artery and pulmonary bed.

• In the presence of normal positioning of great arteries, cyanosis is more prominent and is affected by the size ofVSD.

• Transpositioning great arteries (TGA) and subaortic stenosis are other associated anomalies.

Classification

Tricuspid atresia is classified according to connection between ventricles with great arteries(aorta, pulmonary) into two subgroups:

•   Normal connection between ventricles with  aorta and pulmonary artery . this type is much more common and consistence 70%-80% of cases.Most patients are cyanotic.

• Aorta originated from small  right ventricle and pulmonary artery comes from left ventricle. Heart failure and pulmonary hypertension are common and patients are not cyanotic. Flow in aorta is dependent on VSD size . Subaortic stenosis and aortic arch anomalies are common.