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Eur J Cardiothorac Surg 2005;27:729
© 2005 Elsevier Science NL

Letter to the Editor

Reply to Chatzis et al.

^a Department of Cardiothoracic Surgery, University Hospital,Regensburg, Germany
^b Department of Cardiothoracic Surgery, University of Rostock, Germany

Received 22 December 2004; accepted 23 December 2004.

^* Corresponding author. Department of Cardiothoracic Surgery, University Regensburg, 93042, Regensburg Germany. Address: Tel.: +49 941 944 9801; fax: +49 941 944 9802. (E-mail: wolfgang.goetz{at}klinik.uni-regensburg.de).

Key Words: Absent pericardium • Congenital • Tricuspid insufficiency

Thank you for your Letter to the Editor [1] regarding our report ‘Tricuspid valve repair in a case with congenital absence of left thoracic pericardium’. We appreciate your comments and agree that congenital elements in partial and complete absence of pericardum must be considered. Associated anomalies including mitral stenosis, atrial septal defect, patent ductus arteriosus and tetralogy of Fallot can be found in about 30% of the cases reported with congenital pericardial defect [2–4]. A case of congenital tricuspid valve insufficiency or Ebstein anomaly associated with a pericardial defect was not reported yet. You presented recently the first case of congenital tricuspid insufficiency associated with partial absence of the right-sides pericardium.

In our case we reported the tricuspid annulus was widely dilated due to heart displacement and stretching of the right ventricular anterior wall. The tricuspid valve leaflets appeared of normal structure. The anterior tricuspid leaflet had a normal size and shape but was disrupted from the tricuspid annulus. There existed no further congenital anomalies in this case beside the absence of left thoracic pericardium.

It is to emphasize that any larger pericardial defect including right sided absence of pericardium has an impact on the geometry of the heart and may alter the integrity and function of the atrioventricular valves although a major cardiac displacement is not apparent. In addition we have to be aware that the risk for valvular endocarditis is increased in valvular heart disease and observed valvular thickening or attenuation can be caused by endocarditis [5].

References

1. Chatzis AC, Giannopoulos NM, Sarris GE. Is congenital tricuspid insufficiency (CTI) as rare as it seems to be? Eur J Cardiothorac Surg 2005; doi:10.1016/j.ejcts.2004.12.038.
2. Gray SW, Skandalakis JE. The embryological basis for the treatment of congenital defects. In: Gray SW, Skandalakis JE, editors. Embryology for surgeons. Philadelphia: W.B. Saunders; 1972.
3. van Son JA, Danielson GK, Schaff HV, Mullany CJ, Julsrud PR, Breen JF. Congenital partial and complete absence of the pericardium. Mayo Clin Proc 1993;68:743-747.[Medline]
4. Southworth H, Stevenson CS. Congenital defects of the pericardium. Arch Int Med 1938;61:223-240.
5. Horstkotte D, Follath F, Gutschik E, Lengyel M, Oto A, Pavie A, Soler-Soler J, Thiene G, von Graevenitz A. The task force on infective endocarditis of the European society of cardiology. Eur Heart J 2004;25:267-276.[Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Andreas Liebold Dietrich E. Birnbaum Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Goetz, W. A. Articles by Birnbaum, D. E. Search for Related Content PubMed Articles by Goetz, W. A. Articles by Birnbaum, D. E. Related Collections Congenital - acyanotic