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Straddling & Overriding Tricuspid or Mitral Valve. Seoul National University Hospital Department of Thoracic & Cardiovascular Surgery. Straddling & Overriding AV Valve. 1. Definition 1) Straddling : when a part of tension apparatus of the valve

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straddling overriding tricuspid or mitral valve

Straddling & Overriding Tricuspid or Mitral Valve

Seoul National University Hospital

Department of Thoracic & Cardiovascular Surgery

straddling overriding av valve
Straddling & Overriding AV Valve
  • 1. Definition
  • 1) Straddling : when a part of tension apparatus of the valve
  • crosses the VSD and the crest of the IVS
  • to attach to the septum, or a papillary muscle
  • in the opposite (inappropriate) ventricle
  • 2) Overriding : when the atrioventricular junction to which the AV
  • valve leaflets attach is connected to both ventricle
  • 2. History
  • Lambert : Recognized in 1951
  • Van Praagh : Recognized in 1964
  • Mehrizi : Recognized in 1966
  • Pacifico : Surgical management in 1979
straddling overriding av valve1
Straddling & Overriding AV Valve
  • Morphologic syndromes

1. This anomaly is associated with a posteriorly placed

(juxtacrucial) VSD in the inlet portion of ventricular

septum when viewed from the RV aspect

  • 2. Always occurs in relation to VSD, that is simple
  • part of CHD such as transposition of great arteries,
  • double outlet right ventricle, corrected TGA,
  • double inlet ventricle
  • 3. Straddling & overriding valves are often accompanied
  • by ventricular hypoplasia of variable severity.
  • 4. Overriding or straddling AV valve may occasionally
  • produce subpulmonary or subaortic obstruction.
straddling overriding av valve2
Straddling & Overriding AV Valve
  • Conduction System
  • 1. When AV valve is overriding or straddling a VSD
  • that does not reach the crux cordis, the conduction
  • is usually unaffected.
  • 2. When AV valve overrides a VSD that is juxtacrucial,
  • the AV node is situated anomalously in heart with
  • AV concordant connection.
  • 3. When the VSD is juxtacrucial and AV discordant
  • connection, it is the left AV valve that overrides
  • and the AV node occupies an anterolateral position
  • near right AV valve annulus as is usual in hearts
  • with AV discordant connections.
clinical features diagnosis
Clinical Features & Diagnosis
  • 1. Incidence
  • 3% of CHD
  • More common in discordant connection
  • 2. More prevalent among hearts with AV discordant
  • connection, but in concordant heart it commonly
  • occur in DORV, TGA
  • 3. Coexisting cardiac anomalies generally determine the
  • clinical syndrome, natural history & diagnostic feature
  • 4. Straddling & overriding AV valves are usually
  • competent and have no features
  • 5. Echocardiography is the technique generally accepted
types of straddling tabry
Types of Straddling (Tabry)
  • 1. Type A : Mild, with the chordae that cross VSD
  • attaching to a limited area within 1cm of VSD
  • 2. Type B : Moderate, with the chordae attaching
  • to the septum farther away from VSD
  • 3. Type C : Severe, with the chordae and papillary muscles
  • attached to the inner surface of the free wall of
  • the inappropriate ventricle
techniques of operation
Techniques of Operation
  • 1. Section of straddling cords
  • 2. Slotting of repair patch
  • 3. Reattachment of sectioned tensor apparatus
  • 4. Minor septation
  • 5. Replacement of straddling AV valve
  • 6. One and a half ventricle repair
  • 7. Fontan operation
  • 8. Cardiac transplantation
intraventricular repair
Intraventricular Repair
  • Incorporating a minor septation for straddling & overriding
  • left atrioventricular tricuspid valve in patients with congenitally
  • corrected transposition of great arteries
results of operation
Results of Operation
  • 1. Early & intermediate survival
  • Not satisfactory
  • 2. Heart block
  • 3. Fontan operation or cardiac transplantation
  • Survival after operation is unrelated to cardiac
  • anomaly and not lessened by the presence of
  • a straddling or overriding AV valve.
indications for operation
Indications for Operation
  • 1. Indications for operation lies with the
  • coexisting anomalies rather than with
  • the AV valve anomaly.
  • 2. Strategy of operation is greatly influenced
  • by the AV valve anomalies, and whenever
  • possible that strategy should be decided in
  • very early life.
  • 3. When straddling is severe, septation or even
  • lesser procedure seem likely high early risk