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

Abstract

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.

Two Ventricles Are Not Better Than One in the Fontan Circulation: Equivalent Late Outcomes

“…Importantly, our study suggests that a decision to follow the Fontan pathway should not be based on the presumption that a two-ventricle Fontan circulation is a better or more favorable substrate than the conventional (1V) Fontan circulation for patients. Our study informs consideration of biventricular repair strategies in cases where technical complexity or borderline-size ventricles make anatomic repair challenging, although a direct comparison of approaches in this patient group is yet to be made [15][16][17].…”

Three-dimensional-printed cardiac prototypes aid surgical decision-making and preoperative planning in selected cases of complex congenital heart diseases: Early experience and proof of concept in a resource-limited environment

“…In limited-resource environments, complex lesions with potential for biventricular corrections are often relegated to single ventricle palliations due to resource limitations and uncertainty regarding technical feasibility of complex corrective surgeries. [ 26 ] Now, with increasing expertise, there is a conscious effort to attempt total correction even in technically difficult lesions, but efficient use of resources is important.…”

Case-based approach to demonstrate utility of cardiac magnetic resonance imaging (MRI) for planning biventricular repair with inconclusive echo: illustration of two cases

“…In addition, cardiac MRI calculates ventricular stroke volume, which in conjunction with ventricular volume can be used to quantify valve regurgitation. Cardiac MRI's role in surgical planning often arises when echocardiogram provided inadequate information due to poor transthoracic ultrasound signals, difficult cardiac anatomy, and borderline assessment of ventricular volume and function (1). In particular with our cases, we were interested in the cardiac MRI's more accurate assessment of ventricular stroke volume, ventricular stroke index per body surface area, and valve regurgitation.…”

“…Congenital heart defects that present earlier in life and involving a hypoplastic ventricle are sometimes channeled towards single-ventricle repair because of anatomical or logistic challenges (1). With the single-ventricular repair, the final result is the shunting of venous return directly into the pulmonary artery and the utilization of the functioning ventricle for systemic circulation (2).…”