Angiocardiographic left ventricular volume determination in tricuspid atresia. Comparison of patients with and without palliative surgery.

Group A (n = 10) had reduced pulmonary blood flow and no previous surgery, group B (n = 9) had decreased pulmonary blood flow despite a systemic-to-pulmonary artery shunt and those in group C (n = 10) had increased pulmonary blood flow 9 of whom had no previous surgery and 1 a large Waterston anastomosis. Left ventricular end-diastolic volume (LVEDV) and left ventricular systolic output (LVSO) were higher than normal in all 3 groups with an order of descending magnitude of group C (278 +/- 20% and 264 +/- 32%), group B (264 +/- 19% and 243 +/- 37%) and group A (189 +/- 14% and 190 +/- 13%). For the entire group A, left ventricular ejection fraction (LVEF) was normal (0.66 +/- 0.06 or 97 +/- 8%) with low systemic arterial oxygen saturation (SAO2) averaging 58%, but the LVEF of those infants less than 6 months with a mean SAO2 of 49% was lowered to 0.58 +/- 0.08 or 87 +/- 13% of normal. The ejection fraction was reduced to the greatest extent (0.50 +/- 0.04 or 81 +/- 6%) in group B patients who averaged 12.8 years of age and had undergone shunt procedures 10 months to 13.6 years, median 7.8 years previously. These findings indicate that a moderate degree of arterial desaturation appears to be better tolerated than a chronic volume overload in patients with tricuspid atresia.