Tricuspid atresia

There is no connection between right atrium and right ventricle because the tricuspid valve did not developed. The right ventricle is consequently less developed.

-Fig. 6.7:
Tricuspid atresia. Venous blood in right atrium passes compulsory in left atrium through a atrial septum communication. The pulmonary flow is mantain by the blood that passes through the ventricular septal defect in the small right ventricle and then in pulmonary artery-.

The venous blood coming from the vena cava in the right atrium flows through the foramen ovale in left atrium where it mixes with oxygenated blood coming from the lungs, and then  in left ventricle. From here blood is pumped in aorta and through a VSD in the little right ventricle and in pulmonary artery which is also hypoplastic. There is a  severe cyanosis because the blood pumped in aorta is a mixed of arteriosus and venous blood and the pulmonary blood flow is reduced. Children with tricuspid atresia usually need palliative surgery to increase pulmonary blood flow and mitigate cyanosis. The definitive surgery is not a corrective surgery because it is not possible to create a valve and the right ventricle is so little that it will not be able to lead its function of pump for the pulmonary circulation. The intervention is the Fontan procedure (fig. 6.8) which consist in a total cavo-pulmonary connection. In some cases the VSD is very large and the pulmonary artery well developed; the pulmonary blood is increased and the children are not cyanotic and can have heart failure signs. The palliative surgery in this cases consist in the pulmonary banding. This allows an improvement of the clinical situation and to wait for definitive Fontan surgery.

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