Long-term results of one-and-a-half ventricle repair in complex cardiac anomalies

Abstract

The patients with one-and-a-half ventricle repair resulted in favorable late survival in this series. During the follow-up period, most surviving patients showed good functional status without common late complications of the Fontan procedure such as, recurrent cyanosis, pulmonary arteriovenous fistulas, chronic arrhythmias, and SVC syndrome. This procedure appears to be a valid alternative to Fontan and biventricular repairs in patients with right-ventricular dysfunction or hypoplasia.

Surgical Management of Complete Atrioventricular Septal Defect with Tetralogy of Fallot

“…Except for one hospital death, the rest of the patients are doing well. [17][18][19] To a large extent, one and a half ventricle repair can prevent postoperative RAVV regurgitation with a reduced volume load as well as complete the correction of AVSD and AV valve, which is definitely beneficial to both the anatomy and the phys iology of the hypoplastic right ventricle. Two patients in our group accepted one and a half ventricle repair; during one patient's operation, we decided to perform a directional Glenn procedure for elevated CVP after bypass following biventricular repair.…”

“…Although adding cavopulmonary anastomosis or fenestration ASD to treat elevated CVP is still controversial, the outcome was favorable in this patient. 18,20) In past decades, most children underwent complete repair at the age of 12-24 months. Some patients had pre viously received a palliative shunt.…”

One‐and‐a‐Half Ventricle Repair as a Surgical Alternative to Fontan Revision in an Adult

“…Since its first description in 1989 by Billingsley et al, 14 numerous reports have shown successful extension of the indications for 1 þ 1/ 5 VR to include a variety of anomalies with a functionally or anatomically abnormal subpulmonary RV which is judged unable to cope with the entire pulmonary circulatory volume. 6,7,9,10 The potential benefit of 1 þ 1/5 VR is the achievement of a physiological separation of the pulmonary and systemic circulations with the maintenance of pulsatile blood flow in the PAs. The SVC blood is returned directly to the PAs through a bidirectional cavopulmonary shunt, while the IVC blood flow streams to the PA through the RV, avoiding systemic venous hypertension, and possibly preventing the undesired late drawbacks of Fontan circulation.…”

“…The azygos vein was ligated and an end-toside superior vena caval (SVC)-right PA anastomosis was performed as described elsewhere. 6,7,9,10 After weaning off cardiopulmonary bypass, bipolar atrial and ventricular leads and a DDD pacemaker were implanted. The patient was treated with inhaled nitric oxide to help wean off cardiopulmonary bypass.…”

“…4 However, right atrial to right ventricular (RA-RV) Fontan modification 5 may induce growth of the native RV, providing the option for a ''one-and-one-half ventricle repair'' (1 þ 1/5 VR). 6,7 We present our experience with one patient who underwent conversion from a modified Fontan (Bjork) connection to 1 þ 1/5 VR.…”