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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
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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

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