Rational Approach to Surgical Management of Complex Forms of Double Outlet Right Ventricle with Modified Fontan Operation

Ruzmetov, Mark; Rodefeld, Mark D.; Turrentine, Mark W.; Brown, John W.

doi:10.1111/j.1747-0803.2008.00220.x

Cited by 18 publications

(7 citation statements)

References 22 publications

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“…This is followed by bidirectional cavopulmonary anastomosis (a Glenn shunt) at the age of 6 months, and completion of the cavopulmonary connection at the age of 1 to 2 years. 60) …”

Section: Surgical Treatment and Complicationsmentioning

confidence: 99%

Role of Computed Tomography in Pre- and Postoperative Evaluation of a Double-Outlet Right Ventricle

Kumar

Bhatia²

2021

J Cardiovasc Imaging

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Double-outlet right ventricle (DORV) is a type of ventriculoarterial connection in which both great arteries arise entirely or predominantly from the right ventricle. The morphology of DORV is characterized by a ventricular septal defect (location and relationship with the semilunar valve); bilateral coni and aortomitral continuity; the presence or absence of outflow tract obstruction; tricuspid-pulmonary annular distance; and associated cardiac anomalies. The surgical approach varies with the type of DORV and is based on multiple variables. Computed tomography (CT) is a robust diagnostic tool for the preoperative and postoperative assessment of DORV. Unlike echocardiography and magnetic resonance imaging (MRI), CT imaging is not limited by small acoustic window, need for anaesthesia and can be used in patients with metallic implants. Current generations CT scanners with high spatial and temporal resolution, wide detectors, high-pitch scanning mode, dose-reduction algorithms, and advanced three-dimensional post-processing tools provide a low-risk, high-quality alternative to diagnostic cardiac catheterization or MRI, and have been increasingly utilized in nearly every type of congenital heart defect, including DORV.

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“…This is followed by bidirectional cavopulmonary anastomosis (a Glenn shunt) at the age of 6 months, and completion of the cavopulmonary connection at the age of 1 to 2 years. 60) …”

Section: Surgical Treatment and Complicationsmentioning

confidence: 99%

Role of Computed Tomography in Pre- and Postoperative Evaluation of a Double-Outlet Right Ventricle

Kumar

Bhatia²

2021

J Cardiovasc Imaging

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“…Besides, the surgical strategies in those scenarios are also restrained by age and surgical techniques (15). Most cardiac surgeons may support that a favorable single ventricle is better than two maldeveloped ventricles, as termed as poor biventricular circulation (16)(17)(18)(19). Therefore, under most circumstances above, the single ventricular repair is an alteration with relatively higher priority.…”

Section: Discussionmentioning

confidence: 99%

Impact of 3D Printing on Short-Term Outcomes of Biventricular Conversion From Single Ventricular Palliation for the Complex Congenital Heart Defects

Shi

Pan

Luo

et al. 2021

Front. Cardiovasc. Med.

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Background: Although Fontan palliation seems to be inevitable for many patients with complex congenital heart defects (CHDs), candidates with appropriate conditions could be selected for biventricular conversion. We aimed to summarize our single-center experience in patient selection, surgical strategies, and early outcomes in biventricular conversion for the complex CHD.Methods: From April 2017 to June 2021, we reviewed 23 cases with complex CHD who underwent biventricular conversion. Patients were divided into two groups according to the development of the ventricles: balanced ventricular group (15 cases) and imbalanced ventricular group (8 cases). Early and short-term outcomes during the 30.2 months (range, 4.2–49.8 months) follow-up period were compared.Results: The overall mortality rate was 4.3% with one death case. In the balanced ventricular group, 6 cases received 3D printing for pre-operational evaluation. One case died because of heart failure in the early postoperative period. One case received reoperation due to the obstruction of the superior vena cava. In the imbalanced ventricular group, the mean left ventricular end-diastolic volume was (33.6 ± 2.1) ml/m2, the mean left ventricular end-diastolic pressure was 9.1 ± 1.9 mmHg, and 4 cases received 3D printing. No death occurred while one case implanted a pacemaker due to a third-degree atrioventricular block. The pre-operational evaluation and surgery simulation with a 3D printing model helped to reduce bypass time in the balanced group (p < 0.05), and reduced both bypass and aorta clamp time in the imbalanced group (p < 0.05). All patients presented great cardiac function in the follow-up period.Conclusion: Comprehensive evaluation, especially 3D printing technique, was conducive to finding the appropriate cases for biventricular conversion and significantly reduced surgery time. Biventricular conversion in selected patients led to promising clinical outcomes, albeit unverified long-term results.

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“…Younger age at presentation, low weight and inadequacy of leftsided heart structures were shown to increase the early reintervention risk and late post-repair mortality in these patients after biventricular repair [11,12]. Late morbidity with Rastelli operation is significant due to recurrent left ventricular outflow obstruction (LVOTO), conduit obstruction and arrhythmias [10].…”

Section: Discussionmentioning

confidence: 99%

Two-ventricle repair for complex congenital heart defects palliated towards single-ventricle repair

Kottayil

Sunil

Kappanayil

et al. 2013

Interactive CardioVascular and Thoracic Surgery

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OBJECTIVES: Complex congenital heart defects that present earlier in life are sometimes channelled towards single-ventricle repair, because of anatomical or logistic challenges involved in two-ventricle correction. Given the long-term functional and survival advantage, we have been consciously exploring the feasibility of a biventricular repair in these patients when they present later for Fontan completion.

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Rational Approach to Surgical Management of Complex Forms of Double Outlet Right Ventricle with Modified Fontan Operation

Abstract: FO provides good early- and mid-term results in the treatment of complex forms of DORV. The increased preoperative pulmonary vascular resistance was a significant negative risk factor for adverse outcome in this patient population.

Cited by 18 publications

References 22 publications

Role of Computed Tomography in Pre- and Postoperative Evaluation of a Double-Outlet Right Ventricle

Role of Computed Tomography in Pre- and Postoperative Evaluation of a Double-Outlet Right Ventricle

Impact of 3D Printing on Short-Term Outcomes of Biventricular Conversion From Single Ventricular Palliation for the Complex Congenital Heart Defects

Two-ventricle repair for complex congenital heart defects palliated towards single-ventricle repair

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