Tricuspid Atresia

   
    Tricuspid valve is missing, preventing blood from flowing from the right atrium into the right ventricle. Because the right ventricle has no blood to pump, it remains small and underdeveloped.


1 - atrial septal defect
2 - absent tricuspid valve
3 - ventricular septal defect
Blood is shunted through an atrial septal defect to the left atrium and through the ventricular septal defect to the pulmonary artery. The shaded arrows indicate mixing of the blood.
Pathophysiology



Cyanotic defect resulting in delivery of  inadequately oxygenated blood. 



Child's survival depends on the presence of an ASD and a VSD. The ASD allows the venous blood to flow from the right atrium into the left atrium. There, venous blood mixes with oxygen-rich blood from the lungs, flows to the left ventricle, into the aorta and out to the body. The rest of the mixture is pumped from the left ventricle through the VSD into the right ventricle, and on through the pulmonary artery back to the lungs.



Often associated with PDA
Assessment



History is dependent on amount of pulmonary blood flow (presence of a VSD, degree of PS/PA)



Cyanosis commom early on and expected by 1 month of age due to obligatory  atrial shunt.



CHF history may occur with VSD and no PS



Hypoxic spells occur in 16-45% of patients under 6 months of age.



Clubbing of digits common in patients over 3 months of age



JVD
Management



IV, O2, Monitor.



3cc/kg/hr D10W  for infants under 1 year of age, D5W if over 1 year.



Initial stabalization of tricuspid atresia and pulmonary stenosis is a prostaglandin infusion until surgery.



CHF management for patients with nonrestrictive pulmonary flow, consider Lasix.