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Right ventricular “overhaul”—an intermediate step in the biventricular repair of pulmonary atresia with intact ventricular septum

Published online by Cambridge University Press:  19 August 2008

Ash Pawade ,
Roger B. B. Mee  and
Tom Karl
Ash Pawade
Affiliation:
From the Royal Children's Hospital, Melbourne
Roger B. B. Mee
Affiliation:
From the Royal Children's Hospital, Melbourne
Tom Karl*
Affiliation:
From the Royal Children's Hospital, Melbourne
*
Dr. T. R. Karl, Acting Director, Victorian Paediatric Cardiac Surgical Unit, Royal Children's Hospital, Parkville, Victoria 3052, Australia. Tel. (03) 345-5200; Fax. (03) 345-6386; Internet karl@cryptic.rch.unimelb.edu.au
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Summary

The management of pulmonary atresia with intact ventricular septum remains controversial. The plan for management at our institution is based on the echocardiographic identification of a well-developed infundibulum. Neonates with such a well-developed infundibulum are prepared for a biventricular repair, whereas those without an infundibulum are groomed for a Fontan operation. In all, 48 neonates with the lesion were admitted to our unit between 1980 and 1992. In 31 neonates with a well-formed infundibulum, the initial palliation consisted mainly of pulmonary valvotomy without cardiopulmonary bypass and construction of a polytetrafluoroethylene shunt from the left subclavian artery to the pulmonary trunk. In most of these patients, growth of the right ventricle could be promoted by establishing antegrade flow through the ventricle. In seven patients in this group, nonetheless, the right ventricle failed to grow satisfactorily. In this subgroup, additional intermediate procedures were performed on the apical component and infundibulum of the ventricle together with the tricuspid and pulmonary valves which could collectively be termed as “right ventricular overhaul.” Five of these patients have gone on to further successful biventricular repairs at a median interval of 24 months after the overhaul. There was no operative mortality in this group. Following the final biventricular repair, there have been no late deaths or reoperations over a total follow-up of 145.4 patient months (mean 22.2 months).

Keywords

Right ventricular overhaulpulmonary atresia with intact ventricular septum
Type
Original Articles
Information
Cardiology in the Young , Volume 5 , Issue 2 , April 1995 , pp. 161 - 165
Copyright
Copyright © Cambridge University Press 1995

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