Epicardial
cryosurgery for ablation of atrioventricular accessory pathways has surgical advantages. However, it is applied directly to the valve base. To assess the risk of valve impairment, 10 anaesthetized dogs were subjected to standardized epicardial
cryosurgery of the right atrioventricular junction. Two of these underwent
sham procedure (dissection only). Valve function was assessed by colour Doppler echocardiography preoperatively and at 2 days, 1 week, 2 weeks and 10 weeks postoperatively. Three out of the eight animals subjected to
cryosurgery developed moderate (grade 2/4) tricuspid insufficiency, which appeared at 1 week postoperatively, following regression of congestive oedema. Two out of the three cases of TI were associated with leaflet
prolapse. No tricuspid insufficiency was seen in the
sham-operated animals. At the end of each interval two animals were killed for histological examination. Histological examinations showed that cryolesions extended a maximum of 3 mm into the valve leaflet. The tricuspid insufficiency is attributed to the extensive
scarring (including chondroid
metaplasia), which causes retraction and restricted motion of the annulus. It is concluded that cryolesions may impair atrioventricular valve function. Patients undergoing
cryosurgery should be monitored postoperatively by echocardiography for atrioventricular valve insufficiency.