Hostname: page-component-586b7cd67f-rdxmf Total loading time: 0 Render date: 2024-11-20T17:30:21.288Z Has data issue: false hasContentIssue false
  • English
  • Français

The classical and the one-and-a-half ventricular options for surgical repair in patients with discordant atrioventricular connections

Published online by Cambridge University Press:  13 October 2006

Carl L. Backer ,
Robert D. Stewart  and
Constantine Mavroudis
Carl L. Backer
Affiliation:
Division of Cardiovascular-Thoracic Surgery, Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
Robert D. Stewart
Affiliation:
Division of Cardiovascular-Thoracic Surgery, Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
Constantine Mavroudis
Affiliation:
Division of Cardiovascular-Thoracic Surgery, Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
Get access Rights & Permissions [Opens in a new window]

Abstract

The classical option for surgical repair in patients with congenitally corrected transposition takes advantage of the physiologic correction provided by nature. At the end of the surgical procedures, however, the morphologically right ventricle remains as the systemic ventricle. Surgical intervention is essentially the correction of associated lesions, including closure of ventricular septal defects, pulmonary valvotomy, placement of a conduit from the morphologically left ventricle to the pulmonary arteries, replacement of the morphologically tricuspid valve, and placement of pacemakers for third degree atrioventricular block. For many years, the classical approach was the “standard” surgical approach.1–4 More recently, newer alternatives have become available, including forms of anatomic repair, the “one-and-a half” ventricular option, and conversion to the Fontan circulation. The goal of anatomic repair is to craft connections such that the morphologically left ventricle becomes the systemic ventricle. Surgical techniques that accomplish this are a Rastelli procedure combined with an atrial baffle,5 and the combination of an arterial switch with an atrial baffle, be it a Mustard or Senning procedure.6

Keywords

Congenitally corrected transpositionhypoplastic ventriclescavopulmonary anastomosiscongenital heart disease
Type
Discordant Atrioventricular Connections
Information
Cardiology in the Young , Volume 16 , Supplement S3: Controversies and Challenges of the Atrioventricular Junctions and Other Challenges Facing Paediatric Cardiovascular Practitioners and their Patients , September 2006 , pp. 91 - 96
Copyright
© 2006 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Termignon JL, Leca F, Vouhe PR, et al. “Classic” repair of congenitally corrected transposition and ventricular septal defect. Ann Thorac Surg 1996; 62: 199–206.Google Scholar
Yeh T Jr, Connelly MS, Coles JG, et al. Atrioventricular discordance: results of repair in 127 patients. J Thorac Cardiovasc Surg 1999; 117: 1190–1203.Google Scholar
Biliciler-Denktas G, Feldt RH, Connoly HM, Weaver AL, Puga FJ, Danielson GK. Early and late results of operations for defects associated with corrected transposition and other anomalies with atrioventricular discordance in a pediatric population. J Thorac Cardiovasc Surg 2001; 122: 234–241.Google Scholar
Rutledge JM, Nihill MR, Fraser CD, Smith OE, McMahon CJ, Bezold LI. Outcome of 121 patients with congenitally corrected transposition of the great arteries. Pediatr Cardiol 2002; 23: 137–145.Google Scholar
Ilbawi MN, DeLeon SY, Backer CL, et al. An alternative approach to the surgical management of physiologically corrected transposition with ventricular septal defect and pulmonary stenosis or atresia. J Thorac Cardiovasc Surg 1990; 100: 410–415.Google Scholar
Yamagishi M, Imai Y, Hoshino S, et al. Anatomic correction of atrioventricular discordance. J Thorac Cardiovasc Surg 1993; 105: 1067–1076.Google Scholar
Mavroudis C, Backer CL, Kohr LM, et al. Bidirectional Glenn shunt in association with congenital heart repairs: the 1(1/2) ventricular repair. Ann Thorac Surg 1999; 68: 976–982.Google Scholar
Delius RE, Rademecker MA, de Leval MR, Elliot MJ, Stark J. Is a high-risk biventricular repair always preferable to conversion to a single ventricle repair? J Thorac Cardiovasc Surg 1996; 112: 1561–1568.Google Scholar
Presbitero P, Somerville J, Rabajoli F, Stone S, Conte MR. Corrected transposition of the great arteries without associated defects in adult patients: clinical profile and follow up. Br Heart J 1995; 74: 57–59.Google Scholar
Connelly MS, Liu PP, Williams WG, Webb GD, Robertson P, McLaughlin PR. Congenitally corrected transposition of the great arteries in the adult: functional status and complications. J Am Coll Cardiol 1996; 27: 1238–1243.Google Scholar
Nieminen HP, Jokinen EV, Sairanen HI. Late results of pediatric cardiac surgery in Finland: a population-based study with 96% follow-up. Circulation 2001; 104: 570–575.Google Scholar
Gelatt M, Hamilton RM, McCrindle BW, et al. Arrhythmia and mortality after the Mustard procedure: a 30-year single-center experience. J Am Coll Cardiol 1997; 29: 194–201.Google Scholar
Kreutzer C, De Vive J, Oppido G, et al. Twenty-five-year experience with Rastelli repair for transposition of the great arteries. J Thorac Cardiovasc Surg 2000; 120: 211–223.Google Scholar
Dearani JA, Danielson GK, Puga FJ, Mair DD, Schleck CD. Late results of the Rastelli operation for transposition of the great arteries. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2001; 4: 3–15.Google Scholar
Ilbawi MN, Ocampo CB, Allen BS, Barth MJ, Roberson DA, Chiemmongkoltip P, Arcilla RA. Intermediate results of the anatomic repair for congenitally corrected transposition. Ann Thorac Surg 2002; 73: 594–599.Google Scholar
Bautista-Hernandez V, Marx GR, Gauvreau K, Mayer Jr JE, del Nido PJ. J. Maxwell Chamberlain memorial paper for congenital heart surgery: determinants of left ventricular dysfunction after anatomic repair of congenitally corrected transposition of the great arteries. Presented at 42nd annual meeting, Society of Thoracic Surgeons, Chicago, Illinois. January 30, 2006.
van Son JA, Reddy VM, Silverman NH, Hanley FL. Regression of Tricuspid Regurgitation after two-stage arterial switch operation for failing systemic ventricle after atrial inversion operation. J Thorac Cardiovasc Surg 1996; 111: 342–347.Google Scholar
Mavroudis C, Backer CL. Arterial switch after failed atrial baffle procedures for transposition of the great arteries. Ann Thorac Surg 2000; 69: 851–857.Google Scholar
Dunn JM, Start J, de Leval M. Avoiding compression of extracardiac valved conduits. Pediatr Cardiol 1983; 4: 235–238.Google Scholar
Stark J. The use of valved conduits in pediatric cardiac surgery. Pediatr Cardiol 1998; 19: 282–288.Google Scholar
Mavroudis C, Backer CL. Physiologic versus anatomic repair of congenitally corrected transposition of the great arteries. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2003; 6: 16–26.Google Scholar