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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 [email protected]
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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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References

Greewold, WE, Dushane, JW, Burchell, HB, Fruwer, HB, Edwards, JE.Congenital pulmonary atresia with intact ventricular septum: Two anatomic types. Circulation 1956; 14: 945. [Abstract]Google Scholar
Goor, DA, Lillehei, CW.Congenital Malformations of the Heart. Grune and Stratton, New York, 1975, p 11.Google Scholar
de Leval, MR, Bull, C, Stark, J, Anderson, RH, Taylor, JFH, Macartney, FJ.Pulmonary atresia and intact ventricular septum: Surgical management based on a revised classification. Circulation 1882; 66: 272–280.CrossRefGoogle Scholar
Bull, C, de Leval, MR, Mercanti, C, Macartney, FJ, Anderson, RH.Pulmonary atresia and intact ventricular septum: A revised classification. Circulation 1982; 66: 266–272.CrossRefGoogle ScholarPubMed
Pawade, A, Capuani, A, Penny, D, Karl, TR, Mee, RBB.Pulmonary atresia with intact ventricular septum:Surgical management based on RV infundibulum. J Card Surg 1993; 8: 371–383.CrossRefGoogle ScholarPubMed
Rowlatt, UF, Rimoldi, HJ, Lev, M.The quantitative anatomy of the normal child's heart. Ped Clin N Am 1963; 10: 499–588.CrossRefGoogle Scholar
Karl, TR, Sano, S, Pornvilawan, S, Mee, RBB.Tetralogy of Fallot: Favourable outcome of nonneonatal transatrial, transpulmonary repair. Ann Thorac Surg 1992; 54: 903–907.CrossRefGoogle ScholarPubMed
Billingsley, AM, Laks, H, Boyce, SW, George, B, Santulli, T, Williams, RG.Definitive repair in patients with pulmonary atresia and intact ventricular septum. J Thorac Cardiovasc Surg 1989; 97: 746–754.CrossRefGoogle ScholarPubMed
Freedom, RM, Keith, JD. Pulmonary atresia with normal aortic root. In: Keith, JD, Rowe, RD, Vlad, P (eds). Heart Disease in Infancy and Childhood. Third edition. Macmillan, London, 1978, pp 506–517.Google Scholar
Weldon, CS, Hartmann, AF Jr, McKnight, RC.Surgical management of hypoplastic right ventricle with pulmonary atresia or critical pulmonary stenosis and intact ventricular septum. Ann Thorac Surg 1984; 37: 12–24.CrossRefGoogle ScholarPubMed
Dobell, ARC, Grignon, A.Early and late results in pulmonary atresia. Ann Thorac Surg 1977; 24: 264–272.CrossRefGoogle ScholarPubMed
Freedom, RM, Burrows, PE, Smalhorn, JF. Pulmonary atresia and intact ventricular septum. In: Freedom, RM, Benson, LN, Smallhorn, JF (eds). Neonatal Heart Disease. Springer-Verlag, London, 1992, pp 285–307.CrossRefGoogle Scholar
Anderson, RH, Anderson, C, Zuberbuhler, JR. Further morphologi studies on hearts with pulmonary atresia and intact ventricular septum. Cardiol Young 1991; 1: 105–113.CrossRefGoogle Scholar
Shaddy, RE, Sturtevant, JE, Judd, VE, McGough, EC.Right ventricular growth after transventricular pulmonary valvotorny and central aortopulmonary shunt for pulmonary atresia and intact ventricular septum. Circulation 82(Suppl IVyes) 1990; 163: IV 157–lV 183.Google ScholarPubMed
Schmidt, KG, Cloez, J, Silverman, NH.. Changes in right ventricular size and function in neonates after valvotomy for pulmonary atresia or critical pulmonary stenosis and intact ventricular septum. J Am CoIl Cardiol 1992; 19: 1032–1037.CrossRefGoogle ScholarPubMed
Joshi, SV, Brawn, WB, Mee, RBB.Pulmonary atresia with intact ventricular septum. J Thorac Cardiovasc Surg 1986; 91: 192–199.CrossRefGoogle ScholarPubMed
Graham, TP, Bender, HW, Atwood, GF, Page, DL, Sell, CGR. Increase in right ventricular volume following valvulotomy for pulmonary atresia or stenosis with intact ventricular septum. Circulation 1974; 50(Suppl IIyes); 1169–1179.Google ScholarPubMed
Patel, R, Freedom, RM, Moes, CA, Bloom, KR, Olley, PM, Williams, WG, Trusler, GA, Rowe, RD.Right ventricular volume determinations in 18 patients with pulmonary atresia and intact ventricular septum: analysis of factors influencing right ventricular growth. Circulation 1980; 61: 428–440.CrossRefGoogle ScholarPubMed
Kirklin, JW, Barratt-Boyes, BG: Cardiac Surgery. First edition. Churchill Livingstone, New York, 1986, p 850.Google Scholar
Laks, H, Haas, GS, Pearl, MJ, Sadeghi, AM, George, B, Santuli, TV, Williams, RG.The use of an adjustable interatrial communication in patients undergoing the Fontan and other definitive heart procedures. Circulation 1988; 78(Suppl IIyes): II357. [Abstract]Google Scholar