TRICUSPID

Report

of

Three

By

Cases
L.

HERBERT

ATRESIA

and

Evaluation
M.D.,

ABRAMS,

San

ONGENITAL
absence

and

of
of

failure

of

the

tion

right
of

normal

left

of the

which
atresia.

upper

Tricuspid

border

enlargement

in

this

picture
is one

atresia

anomaly

die

It

has

procedure
The

before

is both

of

authors

present
pertinent

for

The

the

available

have

tricuspid

atresia

or

electrocardiographic

very

In

noteworthy.

Incidence.-Grayzel

the

In

and

a review
to

total

of

the

was

Age

of Death.-Age

in

at Time

which

it

to

were

excluded.

three

fourths

From

the

of

substantiat-

list

that

with
with

the

may

be

with

is generally

ad-

the

Potts-Gibson

tricuspid

atresia.

tricuspid

atresia
the

and

more

the

a review

of

recent

generally

accepted

diagnostic

in which

data

cases

congenital

and

hitherto

44

cases

unreported

of

which

the

of

roentgenologic

were

and

the

LITERATURE

15

since

which

of infants

is desirable.

one

THE

disease

cases

1933,

of

57

tricuspid

additional

atresia
cases

reported

were

prior

found,

to

bringing

72.3_26

Sex.-There

dropped

Tennant

of

three
in

OF

literature

absence

operation

prompted

been

addition,

are

recognicyanosis,

majority

associates

infants

atresia

findings

ventricle

antemortem

heart

infants

reviewed

REVIEW

1933.

young

tricuspid

presented,

is

development

and

The

his

has

are

there

right

roentgenogram,

flow.1,2

limitations

stenosis

the

be : persistent

Blalock-Taussig

anomaly

the

to the
to

congenital

young

of

analyzed.*

been

of

in very

17 years

leading
stated

blood
and

of

and

of normal

projection,

the

this

auricle

in which

deviation.
forms

of

M.D.

ALWAY,

failure

anterior-oblique

Gasul

with

past

are

by

recognition

of the

clues

axis

effective

Awareness

clinical

the
criteria

at which

relief

right

It is this

pulmonary

and

Criteria

anomaly

anterior-posterior

cyanotic

age

experience

literature

left

however,

surgical

literature.

criteria

the

the

the

feasible

possibility

the

the

of left

of

shown,

between

provide

additional

been

is a cardiac

ventricle.

in

H.

ROBERT

stenosis

diagnostic

cardiac

by providing

vised.

should
The

electrocardiographic

alleviated

or
right

AND

Diagnostic

Francisco

comn5unication

ventricle

ventricular

ing

atresia

development

tricuspid

concave
right

tricuspid

of

an equal

noted.

was

12 months

distribution

The

age

dead

the Departments

(12

one

before

age

of Radiology

of

and

from

2 years,
25

the

years

among

females

ranged

was
and

third

the

males

of death

average

if 2 patients

Approximately
were

of

at time

6 days

8 months,
old,

patients

the
although

respectively,

died

by the

reported

to 25 years

the

at time
age

cases.

in 26 cases
average
of

death)

of 6 months,

and

of 1 year.

and

Pediatrics,

Stanford

University

School

of Medicine,

San

Francisco.
(Received
Since

Edwards,
America

this

for publication
paper
was

J. E.,
33:1177,

and

Sept.
completed,

Burchell,

25,

1950.)

the
H.

B.,

following

reference

Congenital

tricuspid

has

been

atresia:

called

to the

Classification,

1949.

660

Downloaded from by guest on October 12, 2016

authors
M.

attention:
Clin.

North

TRICUSPID
Pathologic

Findings.-

only

tricuspid

cases

with
was

normal

in

was

intact

cation

cases
stenosis

In

all

plastic

cases

vessels

the

cases

cases.

Dyspnea

lungs

were

it

ventricle
in

stated

Murmurs

was

definitely

enlarged.

although

the

to

normal

systolic

loud,

and

in

all

in

some.

and

the

The

the

artery

ductus

was

arteriosus

at the

cases,

infundib-

the

foramen

right

thickness
In

six

one

of

of

cases,

communi-

ovale,

ventricle

the

and

was

muscle

in

hypo-

wall

transposition

level

blood

case

of

of

the

the

great

any

ranged

cell

count

Left

axis

have

whom

scattered

not

been

described.

was

was

although

was

present

the

patients.

of
rales

were

in
in

13

The

heard

patients.
pulsation

14

pre-

5 to

was

present

liver

gm./100

was

cc.,

were

fourth

palpable

murmurs
usually

interspace.

in six patients,

present.

with

million/cmm.,

12

They

to the

to be

stated

present

The

murmur.

second

The

to 29

from

the

were

mentioned.

a diastolic

from

definite

Murmurs

specifically

also

sternum

from

in some

in

in seven

ranged

persistent,

Clubbing

common.

there
the

and

period.

paroxysmally

occurrence

of

enlarged
was

or
three,

atresia

left

at birth

neonatal

rest

was

their

in one

these

hemoglobin

red

at

tricuspid

present

the

except

growth

to the

was clinically

only

either

in whom

in all,

after

patients
of

patients

generally

until

physical

maximal

heart
The

noted

diagnostic
28

were

in

the

not

ventricular

pulmonary

to be a patent

stated

; the

stenosis

10 of

had

Among

present.

case,

be

the
and

with

In

every

marked

was

Retarded

of

cases,

two.

of these

as well.

arteriosus

present

arteries,

other

was

was

was

not

was

clear

terminally.

The

left

auricle

defect

Findings.-Cyanosis

a few

but

left

septal

in the

ductus

was

Half

orifice

remaining

defect
pulmonary

valve

20 cases.

present.

was

The

hypoplastic

on

pulmonary

a patent

of the

septal

and

the

all had

In six

at the

right

was

Clinical

20

had

rudimentary

ventricle

two.

661

available
of

atresia,

but

interauricular

or

right

the

an

were

atresia

interventricular

and

between
cases

in

in all
an

Three

in one

data

complete

pulmonary

size,

closed.

six

but

associated

septum

ulum

Autopsy

atresia

ATRESIA

an

average

with

an

of

19 gm.

average

of

million.
Electrocardiographic
obtained

in

weeks

10

old,

In

one

found.2426
and

these

Findings.-Among

39.

were

old

the

thought

Roentgenologic
reproduced

months
of

and

three
to show

23

of

axis

hypertrophy

cases,

and

reviewed,

in

36

old,

without
cases

the

of

cases.

respectively,

In

no

were

three

axis

unipolar

patients,

deviation

leads

was

were

utilized

ventricles.

reviewed,

findings

electrocardiograms

these

deviation,

of both

33 of the

these

cases

1 1 months

caseS

Findings.-In
in

the

deviation

RGs

were

were

obtained.

mentioned

briefly

Films

in

an

were

additional

10.
A.

Postero-anterior

slightly

of

the

more,
than

enlarged.

apex

was

there

was

ings

segment
were

apex

usually

is commonly

artery

view.-In
The

of

not

usually

greater

seen

in the

the

usually

either

left

most
of

the

presence

of

diminished

on

the

of

the

in

lungs

feature

in the

Taussig3

due

that

cardiac

The

arterial

was

heart

usually

the

lower

of

Fallot.

border

noted.

to the

characteristic

lungs
fine,

anastomoses27

was

in size
but

tetralogy

(left

of

Fallot.

The

of

pulmonary

lower

limits

could
mottled

not

the

Furtherborder

pulmonary

vascular

of normal.
have

and

or only
elevation

cardiac

concavity

not

the

ventricular)

A moderate
was

normal

elevated,

in the
left

or at the

flow

either

slightly

found

of

slightly

blood

RGs.

to bronchial

reported
states

tetralogy

upper

the

was

as that

fullness

diminished

stated
the

cases,

heart

as striking

cases,

basis

the

been

reticulated

a prominent

mark-

In some
definitely
pattern

roentgenologic

cases.
in tricuspid

atresia

the

great

vessel

shadow

is usually

Downloaded from by guest on October 12, 2016

narrow

in the

662

HERBERT

frontal

projection.

somewhat

B.

mentioned.

right

anterior
out

posterior

that

oblique

C. Other

the

left

H.

commented

that

reported

cases,

the

general,

this

view

was

one

the

heart
the

number

of cases

Thus,
greater

does

ALWAY
the

aortic

the

not

shadow

presence

appear

is often

of

to be

a narrow

an

important

for
of

the

fact

the

tion,

the

roentgenographic

need

not

be

studies,

the

may

apex

give

the

auricles,

oblique

reported

was

was

the

the

left

diagnosis.

that

into

not

has

by

the

made

forward

view

conclusions.

in establishing

projected

She

cases,

definite

statement

lateral

view.

is expressed

the
any

of

to project

at fluoros-

what

utilized

was

con-

in a sufficient

diagnosis

best

demonstration

of

atresia

in

postero-anterior

lower

tricuspid

that

of

the

of the

tetralogy

the

of

enlarged

be made
and

significance

left

left
1.

in the

frontal
right

a large

left

have

and

lateral

by the observation

the

small

et al.26

oblique

are:

shown
the

Cooley

frontal,

of
of

in

and

auricle

of

or visualization

that

border

evidence

in the

should
left

is somewhat

there

is somewhat

the

Fallot.

frontal

The

ventricle

projecview

left

and

anterior

of absence

of

ventricle.

atresia

the

and

cardiac

from

adequate

right

findings

three

In

presence

border

ventricular)

appearance

tricuspid

auricle,

the

view

the

heart

anomaly

helpful

the

The

(left

Angiocardiography.-Brown4
of

is not

atresia,

that

the

anterior
this

to permit

view

the

lower

dissimilar

of the

studies

border.

oblique

that

left

strikingly

view

left

cardiac
sufficiently

ventricle.

fact
of

to be evaluated.

fullness

enlargement

the

in

oblique

right

the

by failure
in

posterior

anterior

the

stressed

enlargement

tricuspid

right

of

shadow

utilized

proved

the

region

except

oblique

the
not

right
of

in

sidered

aortic

of

case

has
is suggested

ventricular

views.-The

at least

right

of

In

ventricle

to
the

displacement

anterior

D.

ROBERT

has

third

view.-Taussig

rudimentary

pointed

copy

one

anterior-oblique

or

significantly

In

however,

about

was

AND

feature.
Left

small

In

shadow

diagnostic

ABRAMS

Neuhauser,7

enlarged.

mediastinal

L.

ventricle.
The

et al.26
of

seen

shown

equally

have

of the

pointed

out

a communication
of the

in the

well

adequate

opacification

2. Nonvisualization
best

With

of sequential
Cooley

projection.

angiocardiographic

projections.

demonstration

ventricle,

ventricle,

reported

lateral

in the

right

ventricle,

projection.

frontal

that

between
3. The

or lateral

projec-

tions.
Cardiac

Catheterization.-Studies

although

they

septal

may

defect

with

be highly

and

inability

suggestive.

intracardiac
They

to catheterize

the

right

CASE
Case

she

1.

E.G. : A 5 wk.

steadily

cyanotic,

lost

murmurs

and

did

not

Unipolar

were

heard.
Hgb.

gave

Supracardiac
border

vascular

3 ) , and

posteriorly,

as

well.

thought

In

addition,

performed
vena

at

increased

the
to
in

edge

be

to

but
am-tic

failed

with

L oblique
10

up

of

crying.

was

palpable

cc.
to

its

Routine

to
in

conclusive,

the

view,

of

35%

point

in

at the

level

the

the

in
LAO

junction

to

were

Downloaded from by guest on October 12, 2016

the

probably

in-

(Fig.
2

lateral

1).
Heart
view

R ventricular

border

projected

far

clear.
into

the

umbilicus
deviation.

view

( Fig.

in

cardiac

injected

axis

P-A

view

abnormally
with

percussion.

examination,

and
and

and

showed

no

the

view

posterior

poorly

of the

showed

enlargement

diodrast#{174}
of

enlarged

roentgenologic

LAO

fields

taken

Examination

was

enlarged

widen

were

wk.

Heart

massively

Lung

studies

R auricular

enlargement.
cava

be

shadow

marked

the

not

of an interauricular

Feedings

age

hypertrophy.

heart

narrow,

to

with

Liver

birth.

at

the

cc. Electrocardiographic
the

L ventricular
inferior

cyanotic

hospitalized

clear.

are

presence

REPORTS

L ventricular

was

was

indicating
the

of

anterior

Angiocardiography,
demonstrated

were

showed

pedicle

there

was

the

ventricle.20

was

17 gm./100

evidence

well

infant

Cyanosis

Lungs
was

fluoroscopy,

extended

enlargement

no

and

she

infant.

pulsate.

films

female

until

nourished

leads

eluding

( Fig.

weight

poorly

No

old

catheterization

demonstrate

heart

the
on

R
the

femoral
initial

vein,
film.

TRICUSPID

FIG.

1.

Case

1.

P-A

view.

Heart

is

Great
FIG,

2. Case

1.

On

the

second

film,

and

L ventricle,

was

the

possibility

revealed

that

minimal

taken

at

well

view.

vena

opacification

(Fig.

in

4).

cava

the

is

sec.,

the

of

are

abnormally

clear.

the

anteriorly.

spine.

side

also

into
the

fields

bulges

behind

aorta

emptied

region

border

projects

The

Lung

narrow.

heart

border

approximately

663

enlarged.

shadow
Anterior

heart

opacified
inferior

the

massively
vessel

LAO

Posterior

ATRESIA

of

was

the

heart,

including

visualized.

L auricle.

R auricle,

These

Review

suggesting

of
the

the

findings
the

films,

presence

auricle

suggested
however,
of

tricuspid

atresia.
The

ratients

tricuspid
The

a large

ventricular

FIG.
FIG.

condition

atresia,

4. Case

wall

3. Case

remained
atrial

poor

septal

was

of

1. L lateral

normal

view.

of

heart

she

died

pulmonary
thickness

Anterior

at 2 sec.

1. Angiocardiogram

and

defect,

LAO

is clearly

4 days
atresia

but

heart

view.
seen.

the

border

after

and
R

ventricular

projects

Opacification
Aorta

admission.

a patent

Autopsy

ductus
cavity

forward

arteriosus
was

disclosed
(Fig.

essentially

5).
an

prominently.

of inferior

is visualized.

Downloaded from by guest on October 12, 2016

vena

cava

and

L side

664

HERBERT

endothelial-lined
through

slit.

the

the

of

the

in

5.

the

Case

birth.

1.

2.

present.

entire

precordium.

gm./100

and

of

the

examination

In

producing

A Potts
This

the

LAO

operation,

Case

count

RH.:

in

In

the

a
LAO

the

Lungs

cyanotic

the

distant

from

filling

of

the

the

chest

heart

spine.

fluoroscopy

anterior

projected

to

at

with
establish

border

but

the

to

posterior

considered,

supply

infant,

failed

cardiac

projected

was

blood
arteries.

leads

view,

border

immediate

their

pulmonary

unipolar

oblique

almost

received
left

incapacitated
and

cardiac

ALWAY

and

markedly

deviation

and

there

flat

anterior

and

Anterior

seen

at

below

the

cmm.

and

L ventricular

7)

at the

is alive
on

of

(Fig.
and

ECG

the
.

of

relatively

findings
and

because

of

the

wall.

aorta,

margin,

The

further

murmur

was

heard

suggested
was

well

contour

and

presence

followed
atresia:

roentgenographic

of

the

and

20

slight

L lower
the

aortic

of a small

cardiac
shadow

R ventricle.
improvement.

3 yr.

persistent

studies

the

was

Roentgenologic

by marked

age

was

over

segment

of

since

toes

Hgb.

deviation.
artery

at the

in tricuspid

pulsate.

fullness

the

1 yr.,

not

ventricle.

cyanosis

and

pulmonary

was

left

thumbs

L axis

There

V.,

of

did

showed

L.

persistent

clubbing

R ventricular

This

age

auricle.

systolic

concave

6).

right

and

ECG
a

continuity

mo.

costal

(Fig.

the classical

boy

noted
blowing

enlargement,

border

deviation

of

was

projection

he

age

A.,

R.

A high-pitched

on the child

old

the

million

was

and

view.

cyanosis

9.5

frontal

view,

6 mo.

situ.

cardiac

the

L axis
A

axis

narrow

clear.

was

case illustrates

R ventricle
3.

of

no

finger-breadths

performed

This

right

markedly

first

were
4

persisted,

polycythemia,

band.

small

vessels

marked

minimal

apex

improvement

of a small

fields

RBC

a relatively

Comment:
and

was

Liver,

showed

elevation

atretic

great

in

examination,
Lung

cc.

was

specimen

infant

physical

already

border.

: An

view

an

posterior

of

H.

of transposition.

Autopsy

S.H.

On

the

demonstrated

possibility

Case

and

ROBERT

with

problem

showed

transposition

LAO

which

eliminated

the

aorta,

of

the

was

hypertrophy.

the

possibility

shadow

artery

ECG

to

AND

communicated

presented

L ventricular

angiocardiogram

FIG.

case

anterior

Initially

which

enlargement.

presence

significantly

ABRAMS

pulmonary

ductus,

This

cardiac

vessel

Main

patent

Comment:
massive

L.

marked

suggesting

the

cyanosis
presence

enlargement.
had

been

cyanotic

since

about

24

Downloaded from by guest on October 12, 2016

hr.

after

birth.

At

that

time

TRICUSPID
RGs

were

made

Following
and

feeding.
was
At

consistent

dextrocardia

pulmonary

autopsy

revealed

Foramen

L pulmonary

Comment:

Roentgenologic

established

artery

by the
the

was

findings
segment

dextrocardia,
diagnosis

8).

died

and
failed

but

was

at

orifice,

He

massive
this

elevation
to clarify
not

used

thought

the
since

were

too

In

fingers

16 gm/lOU
not

noted.

poor

and

the

blood

R nipple.

and

toes

was

cc. ECG

was

fields

a risk
to

for

the

and

operation

dextrocardia,

a hypoplastic
from

showed

the

Roentgenologic

lung

addition

atresia

of

of the

nature
the

be

made.
crying

R ventricle.

the

aorta

clear

lung

into

the

enlargement.
those

apex

of

avascular

age.

carried

ventricular

of the

was

to
of

artery

arteriosus
child

of

moderately

7 mo,

region
of

Hgb.

was
with

examination

the

Clubbing
and

type

associated

Physical
in

hypertrophy

pulmonary
left

was

mo.
best

margin.

was

about

ductus
on

of
heard

dextrocardia,

undetermined

dyspnea

million/cmm.

of

(Fig.

age

costal

presence

a patent

There

the

of R ventricular

He

and

the
of 9.3

of

Severe

murmur

evidence

of tricuspid

patent
arteries.

pulmonary

complicated
have

was

count

segment

unimproved.
hypoplasia

ovale

concave

the

at

systolic

665

anomaly

persisted.

hospital
below

RBC

but

artery

discharged

the

a variable

an

cardiac

cyanosis

fingerbreaths

demonstrated

was

to

and

he had

time

of a congenital

nursery,

admitted

cyanosis

palpable
with

concave

the

that

examination

R and

was

deep

present.

and

the diagnosis
from

He

generalized
Liver

and

discharge

ATRESIA

of
child

dextrocardia,

heart.

Electrocardiographic

the

anomaly.

was

considered

fields,

Angiocardiography
too

Downloaded from by guest on October 12, 2016

poor

findings,
a surgical

might
risk.

666

HERBERT

L.

ABRAMS

AND

ROBERT

H.

ALWAY

DISCUSSION

Routine

clinical,

to establish
depend,

roentgenographic

the

diagnosis

however,

The

blood

either

an

flow

From

atresia

is from

defect

or

septal
left

(1 )

if an

interventricular

tary

right

ventricle

( 2)

the

then

the

ventricle

the

septal

artery,

pulmonary

right

are

usually

pre-operative

sufficient

diagnosis

way

the

may

blood

a patent

left

and
pass

may

ductus

through
to

or

ventricular

(3 )

or

left
ways:

a rudimen-

normal

septum

arteriosus

the

in three

through

hypoplastic

or the

auricle

thence

be supplied

may

is either

be atretic,

of

to the
ovale

circulation

which

may

auricle

foramen

is present

artery

is by

the

a patent

defect

however,

flow

studies

A definite

pulmonary

to a pulmonary

pulmonary

atresia.

studies.

in tricuspid

the

electrocardiographic

tricuspid

on additional

interauricular

ventricle.

and

of

in

size;

intact,

and

the

bronchial

arteries.

These

different

tations.

Thus,

ment

and
in

logic

produce

variations

between

pulsation

tricuspid

group.

may

opening

a presystolic

findings
cyanotic

pathways

if the

atresia

of
do

Differential

the
the

not

in the

auricles
liver

margin.

distinguish

diagnosis

on

the

and

there

In

this

depends

clinical

is small,

roentgen

may

be

manifes-

hepatic

enlarge-

general,

however,

the

malformation

from

others

electrocardiographic

and

physical
of

the

roentgeno-

findings.

Electrocardiographic
atresia

is the

left

axis

the

great

Fallot

Findings.-The

only

congenital
In

deviationl4,15,1719

vessels

and

Sokolow

whose

left

axis

and

statement

cardiac

ECG

1939

deviation

cyanotic

cases

these

had

tricuspid

osus,

and

the

with

left

atresia,

axis

two

has

one

had

the

tricuspid

with

associated

a patient

with

transposition

of

A child

with

the

tetralogy

of

and

associates.2C

described

ECGs

by

Gasul

in congenital

left

heart

ventricular

a truncus

tetralogy

that

group

reported

or

had

frequently

cyanotic

deviation.
been

unipolar

deviation

while

remaining

axis

ECG

of

made

in the

et al.28

left

on

Edgar,3#{176}in a study

Six

Ash

showed

been

has

malformation

hypertrophy.

arteriosus
of

and

Fallot

disease,

with

found
Three

a patent
associated

of

ductus

arteri-

patent

ductus

arteriosus.

It

is apparent,

congenital

then,

heart

disease

Conversely,

out

Of

literature,
was

three

none

was

may

left

study

in the

show

the

deviation

and

artery

deviation
young

left

axis

deviation

of tricuspid

not

tricuspid

except

always
may

be seen
without

infant.

The

in

a cyanotic

child

with

deviation.

Taussig

atresia.

manifest

atresia

deviation

hypertrophy.
congenital

of

usually

of age.

left

in very

present

axis
young

left

axis

infants

deviation

authors

left

standard

The

cardiac
ventricular

for

with

tricuspid

reported

Patient

in

in the

E.G.,

however,

use

defects

projection.
presence

of

cases,

relatively

of unipolar
is of

hypertrophy

early,

the use of unipolar

precordial

further
in

not

be

leads

electrocardiographic

importance

vertical

it may

precordial
in that

hearts

showing

this

may

right

axis

leads.3

frontal
the

is manifest

In these

Findings.-Classically

elevation

segment

axis

1 1 months

presence

in the

less

as

ventricular

Roentgenologic
Fallot

of

in a very

cyanotic

in the

enlarged

axis

left

as late

show

no
cases

need

of

of age.

although

apparent

presence
be diagnostic

atresia

that

the

7 weeks

Thus,

the
not

tricuspid

pointed

1947

atresia.

that
need

the

is concave.

of
apex
The

the
The
slightly
because
lung

heart

appearance
greater
of
fields

is
may

fullness

normal

in

resemble
of

the

left

the

enlarged

left

are

relatively

avascular.

Downloaded from by guest on October 12, 2016

size

that

of

or

but

the

tetralogy

lower

ventricle.

cardiac
The

In

the

slightly
of
border

pulmonary
left

anterior

TRICUSPID
oblique

view,

enlargement.
That
by

the

Case

straightened
findings

classical

was

vessel

shadow.
view

position

an

aorta.

the

of transposition

The

great

In

the

anterior

of

right

ventricular

heart

border

it was

posterior

always

in

all

heart

left

thought

that

behind

spine

ventricular

far

the

an

was

enlarged

an

transthere

no

of

the

root
right

prominent

suggested

anterior

made

to the

The

great

left

only

anterior

part

narrow

fields,

not

artery

postero-anterior

in

lung

suspected.

strongly

pulmonary

widen

view,

in

demonstrated

a strikingly

clear

oblique

was

The

to

the

represented

the

right

in the

with

it extended

enlargement

of
is clearly

heart

failed
with

but

this

the

vessels,

anterior

border,

present

of

however,

the

absence

projections.

configuration

in conjunction

possibility.

the

2.

are not

shadow,

This,

of

Case

of the great

vessel

667

suggests

by

enlarged

Indeed,

that

Although

the

massively

concave.

unlikely

presence

the

was

border

illustrated
findings

at fluoroscopy.

straightening

of

heart

not

resembled

oblique

anterior
are

roentgenologic

1 . The

segment

view

the
These

ATRESIA

auricle,
extension

enlarged

left

yen-

tricle.
The

portion

an

enlarged

the

anterior

sign

may

of

to

ventricular
transposition

of

dextraposed

aorta,

In

great

the

noted

was

aorta

right

in

ventricle.

congenital

When

vessels,

or

be

in

smooth

straight

aorta

the

presence

anterior

size

of

the

is most

useful

in

In

1, the

region

border

at autopsy
the

to be

prominence

of

proved
to be misleading.
This
ventricular
shadow
to project
anomalies

is anteriorly

of

right

shown
Thus,

cardiac

the

continuity

chamber

placed

of

a right-sided

the

aortic

and

left

anterior

in

the

ventricle

becomes

in

which

as

in

right

complete

aorta
right

or

oblique

more

of

ventricular
view.

difficult

to assess

projection.

Angiocardiography
diagnosis

is obscure.

The

that

the

of

drainage

fact

possibility
revealed
nosis

be

may

a relatively

situations,

this

also

is present.

there

forming

such

in

may

the

to the

hypoplastic

to the ascending
aorta
in that failure
of the right

misleading

aorta

anterior

the

in relation

enlargement

shadow,

projecting
and

border

further
the

heart

auricle

heart
be

anterior

the

right

the
of

Case

right

auricle
of

presence

tricuspid

of

did

the

inferior

early

faint

those

not

cases
of

right

to

opacify

into

the

appear

vena

cava

right

which

the

auricular

are

atypical

and

ventricle

was

significantly
left

Review

and

the

opacified.

brought

auricle.

opacification

in which

never

up

the

of the

films

the

diag-

suggested

atresia.
CONCLUSION

Because

the

surgery,

the

In

cases

most

antemortem
criteria

be recognized
with

left

the

absence

atresia.

axis
of

findings
is by

axis

of
no

on

right

ventricle

may

be

atresia

their

limitations-must

lead

the

ECG
need

obscured

be

the

to

an

only

does
not

may

unequivocal
of

not

in the

corrective

clearly

exclude

cardiac

delineated.

diagnosis.

But

of

cyanotic

tricuspid

the

atresia.

it must
type

Conversely,

the

possibility

of tricuspid

The

presence

of an under-

conventional
of

to

anomaly

be conclusive.

method

lead

be

cardiac

pathognomonic

studies

may

tricuspid

a congenital

means

deviation

roentgenologic

angiocardiography

will

combination

deviation
left

of

diagnosis-and

classical
the

Similarly,

developed
cases,

the
that

diagnosis

for

examination.

establishing

the

In

diagnosis

atypical
conclu-

sively.
For

the

diagnostic

to clarify
the

danger

intensely
procedures

the nature
may

be far

cyanotic
should

young
be

of the anomaly.
less than

infant

performed

Although

in conservative

whose

immediate

whenever

some

prognosis

conventional

risk

management

is attached
of-such

is poor,
methods

to these
cases.

Downloaded from by guest on October 12, 2016

have

special
failed

procedures,2

. 668

HERBERT

L.

ABRAMS

AND

ROBERT

H.

ALWAY

SUMMARY

The

recent

reported

literature

cases

are

on

congenital

described.

The

tricuspid

atresia

generally

is reviewed.

accepted

Three

diagnostic

previously

un-

discussed

and

criteria

are

to

Blalock-Taussig

elaborated.
ACKNOWLEDGM

Dr.

Ann

Purdy

permitted

the inclusion

ENT

of Cases

2 and

3.

REFERENCES
1. Taussig,

Helen

tion,

2.

W.

Gasul,

137:343,

B. M.,

young
4.

Grayzel,

S., Aortic

E. H.,

heart

pulmonary

amenable

anastomosis

successful

D.

and

Tennant,

artery

from

L. M.,

and

J. J., and Davis,

Marino,

with

Blackford,

of

opera-

in congenital

pulmonary

stenosis,

1948.

Fell,
M.,

malformations

1948.

infants

coronary
5.

of

Heart

J.A.M.A.
3.

Analysis

J. 36:321,
J., and Gibson,

Am.

Potts,

B.,

operation,
R.,

Congenital

pulmonary

Hoppe,

C. B., Tricuspid
78: 16,

atresia

artery,

of

tricuspid

10:791,
of case of tricuspid

L. D., Report

Report

of

2 cases

of

origin

of

1949.

orifice

J. Path.

Am.

atresia:

J. Dis. Child.

Am.

and

anomalous

1934.

J. Tech.

atresia,

Methods

13:

123,

1934.
6.

Brown,

7.

Taussig,

J. W.,

Congenital

Helen

to

B.,

defective

Amolsch,
labium

9,

L.,

majus,

J.

Roberts,
Klein,

H.,

and

Rare

defect

Methods

11.

Holder,

E. C.,

and

with

Taussig,

Helen

11:275,

congenital

associated

with

1936.
malformations

tricuspid

of

atresia

or

heart

due

hypoplasia,

tricuspid

valve

complicated

by congenital

myxosarcoma

of

1937.

pulmonary

and

tricuspid

atresia

with

right

ventricular

1937.

malformation

of

heart

Virchows

with

Arch.

J., Congenital

Pick,
septal

L. J.,

associated
13.

of

24:777,

valve,

in

rudimentary

f. path.

development

of

301: 1, 1938;

Anat.

right

ventricle

J.

abstracted,

Tech.

1938.

ventricle,

Manhoff,

of

tricuspid

18:152,

right
12.

case

of

Childhood

1936.

atresia
Path.

Dis.
findings

ventricle

H., Case of congenital

J. Tech. Methods
17:97,

hypoplasia,
10.

Arch.

right

59:435,

Hosp.

Congenital

Arch.

pathological

of

Hopkins

A.

atresia,

and

development

Bull. Johns
8.

tricuspid

Clinical

defects

and Howe,
transposition
B.,

heart

and

patent

disease:
ductus

J. S., Congenital
of great vessels,

heart
Am.

Malformations

of

Congenital

Atresia
arteriosus,

of tricuspid
orifice, hypoplasia
of
J. Tech. Methods
19: 135,
1939.
Tricuspid
atresia
and mitral
atresia

disease:
Heart J. 29:90,
Heart,

New

1945.

York,

The

Commonwealth

Fund.

1947.
14.

Dunsky,

1., Tricuspid

heart,

15.

Arch.

Alexander,

atresia,

Path.

F.,

and

case,
17.

Robinson,

Am.
18.

Dushane,

Miale,

A.,

21,

Fell,

in

J. E., Dry,
adults,

E.

Swan,

Proc.

H.,

Arch.
22.

infants,

M.

Gasul,

Clin.

T.
Staff

H.,

Maresh,
35:604,

important

of Fallot,

aorta,

Logan,

congenital

Ann,

mt.

associated

cardiac

Med.

G. B., Congenital

defects

of trilocular

of tricuspid

correlation

North

Davis,

causing

cyanosis

1947.

of tricuspid

orifice:

Report

of

valve

with

transposition

of great

vessels,

1948.

of some

America

32:879,

T. J., and

interventricular

M.,

conditions

27:64,

atresia

Custer,

septal

less common

C.

B.,

and

cyanotic

congenital

cardiac

1948.

G. S., Congenital

defects,

Am.

J., and Burchell,

H. B., Atrial septal
Meet., Mayo Clin. 23:510,
1948.

B.

and

1947.

A. L., Beno,
and

Surg. 59:445,

Pediat.

Four

J. E., Atresia

Howard,

interauricular

Geraci,
in

and

J. B., Millard,

with
20.

D.,

tetralogy

J. Dis. Child.
75:575,
J. W., Clinical-pathologic

defects
19.

P.

from

J. E., Dry, T. J., and

J. Tech. Methods
27:62,

Edwards,

transposed

1947.

White,

to be differentiated
16.

hypoplastic

43:412,

Casas,

R.,

tricuspid

Heart

J.

defect

and

Surgical

atresia

36:438,

probable

treatment

associated

1948.

of

tricuspid
tricuspid

atresia
atresia,

1949.
G.

J.,

and

Fisher,

G.

R.,

Criteria

of

operability

1949.

Downloaded from by guest on October 12, 2016

in

tricuspid

stenosis,

J.

TRICUSPID
Campbell,

23.

M.,

24.

Brown,

25.

Elster,

and

Hills,

T.

J. 12:65,
1950.
J. W., Cyanotic

Heart

S. K.,

H.,

Angiocardiography

congenital

Congenital

ATRESIA

heart

atresia

in

disease,

of

pulmonary

II.

Observations

669
cyanotic

Overseas

and

congenital

4:

Postgraduate

tricuspid

heart

valves,

173,

disease,

1950.

J. Dis.

Am.

Brit.

Child.

79:692,

1950.
26.

Cooley,

R. N.,

Sloan,

disease

of

heart
of

27.

right

ventricle,

Neuhauser,

E.

genital
28.

Ash,

B.

ovale

J. Pediat.

Sokolow,
Dotter,

progress:

of

and

heart

35:413,

Recent
great

showing

Edgar,

A.

ventricular

M.,

marked

L.,

Study

aliviada

mediante

desde

its

to the

F. S., Death

de

un

el
Esta

hacia

cardiografico
autores

reportan

autores
Ia

que

grandes

tetralogia

Ia

presencia

Clay

como

and

242:753,

de

el

Webster

un
unico

del

de

and

de

of

con-

1950.

left

in infancy,

with

axis

patent

deviation,

de

electrocardiograma,

un

persistencia

del

eje

ventriculo
metodo

del

en

derecho
de

del

de

conducto

arterioso.
no

Ia presencia

ex#{225}men angio-

auricula

izquierda

uno

de

los

electrocardiograma
tamaiio

del

cianotico
de

con

con

tales

desviaci#{243}n

Ia
en
de

Streets

Downloaded from by guest on October 12, 2016

Ia

rutina

trans-

intrauricular,

presencia
todos

angicardiografico

eficaz.

tricuspidea,

como:

comunicaci#{243}n

el ex#{225}men radiologico

tricuspidea.

atresia

Viceversa,

se

derecho.

atresia

una

ocurre

cuales

ventriculo

de tipo

examen

y presencia

de

siempre
un

de

diagn#{243}stico

Fallot

persistente

Ia hemoglobina,

El

congenitas

de

ser

derecho.

patognomonico

cardiopatIas

cianosis

radiologica

del

puede
y Ia circula-

de

congenita,

eje

aumento

sugiere

una

derecha,

congenitas

otras

a veces

de

ventriculo

del

es

Diagn#{243}stico
Ia cual

izquierdo.

auricula

tetralogia

peque#{241}o. Se

diagn#{243}stico

1950.

aumento

ventriculo
del

electrocardiograma

se se#{241}alaque

54:527,

Criterio

Ia presencia

indic#{243} el

no

arteriosus,

con

particular
1950.

cianotico,

diagnostico,

tricuspidea

angiocardiografico

Ia asociaci#{243}nde cardiopatlas

Fallot

Ia

Ia izquierda
con

del
tipo

y evidencia

o estenosis
hacia

presentarse

with

J. 40:232,

Ia circulaci#{243}n pulmonar

por

significante

del

truncus

entre

tama#{241}o del

eje

puede

disease,

Heart
Radiology

de

sin valor

que

vasos,

Am.

congenita

progresiva

atresia

heart

value,

electrocardiograma,

consistentes
examen

Similarmente,

de

hypertrophy

y Evaluaci#{243}n

se caracteriza

Ia desviacion
el

Ia izquierda

tricuspidea.

dudosos

hypoplasia

diagnosis

J. Med.

congenital

comunicacion

de opacificacion

casos

de

combinaci#{243}n
los

eje

aparentemente

del

desviaci#{243}n hacia
atresia

tres

estiman

dicha
Ia

with

ABSTRACT

sistolicos

opacificaci#{243}n

embargo,

izquierda

posici#{243}n de
y en

sin

una

de soplos

ausencia

Ia ausencia

caso,

Los
hacia

Ia
con

radiologicos

este

in congenital

atresia

roentgenographic

angiocardiography,

Casos

peque#{241}o y aumento

demuestra

signos

En

de

del

derecho

izquierdo,

Los

or

authors.

cardiopatIa

generalmente

Ia izquierda

caracteriz#{243} por

ya

establecimiento

cardiopatIa

Tres

es una

in

diagnostic

following

de

tricuspidea

Ia ocurrencia

ventriculo

ventriculo

de

: Reporte

el nacimiento,

desviaci#{243}n

Angiocardiography

England

ventricular

V-leads

and

communication

Jackson,

estenosis

ci#{243}ngeneral.

in

New

left

of

hypertrophy

Personal
and

Tricuspidea
atresia

T.,

stenosis

advances

vessels,

SPANISH

La

H.

on tricuspid

1949.

and

to
C.,

Atresia

Bahnson,

1950.

Medical

(pentalogy)

M.,

reference
32.

54:848,

and

Child.

M.,

Sokolow,

31.

D.,

R.,

Wolman,

J. Dis.

forameri
30.

B.

C.

I. J., and Bromer,

R. S., Diagnosis
of congenital
cardiac
defects
58:8, 1939.
Richmond,
J. B., and Krakower,
C. A., Case of tetralogy
of Fallot

Rachel,

Gasul,

Hanlon,
type.

Radiology

malformation

Am.

29.

R. D.,
cyanotic

los
no

de

una

casos

de

demuestra
en

casos

TRICUSPID ATRESIA: Report of Three Cases and Evaluation of Diagnostic Criteria

HERBERT L. ABRAMS and ROBERT H. ALWAY
Pediatrics 1951;7;660
Updated Information &
Services

including high resolution figures, can be found at:

/content/7/5/660

Permissions & Licensing

Information about reproducing this article in parts (figures, tables)

or in its entirety can be found online at:
/site/misc/Permissions.xhtml

Reprints

Information about ordering reprints can be found online:

/site/misc/reprints.xhtml

PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly publication, it
has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked by the
American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007.
Copyright 1951 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 0031-4005.
Online ISSN: 1098-4275.

Downloaded from by guest on October 12, 2016

TRICUSPID ATRESIA: Report of Three Cases and Evaluation of Diagnostic Criteria

HERBERT L. ABRAMS and ROBERT H. ALWAY
Pediatrics 1951;7;660

The online version of this article, along with updated information and services, is located on
the World Wide Web at:
/content/7/5/660

PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly publication,
it has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked
by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village,
Illinois, 60007. Copyright 1951 by the American Academy of Pediatrics. All rights reserved. Print
ISSN: 0031-4005. Online ISSN: 1098-4275.

Downloaded from by guest on October 12, 2016