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Ann Thorac Surg 1998;66:678-680
© 1998 The Society of Thoracic Surgeons
ventricle repairs
a Division of Cardiac Surgery, Hospital for Sick Children, University of Toronto, Toronto, Canada
b Division of Cardiology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
Address reprint requests to Dr Van Arsdell, Division of Cardiovascular Surgery, The Hospital for Sick Children, Rm 1525, 555 University Ave, Toronto, Ont, Canada M5G 1X8
Presented at the Workshop on "One and One-Half Ventricle Repairs," Gubbio, Italy, Dec 6–7, 1996.
Abstract
Background. Perioperative and long-term problems associated with the Fontan circulation are substantial. There has been an exploration of extending the limits of a biventricular ventricular repair by using a superior vena cava-to-pulmonary artery anastomosis. This type of repair is known as a 1
ventricle repair.
Methods. Patients having defects of the pulmonary ventricle in size or function have undergone 1 ventricle repairs with or without creation of an atrial septal defect. Repairs with tricuspid z values as small as -10 and predicted pulmonary ventricular volumes as low as 30% have been reported. The 1 ventricle repair technique has also been used in special situations associated with an arterial switch or double switch procedure.
Results. Mortality has ranged from 0% to 12%. Complications have included persistent elevation of superior vena cava pressure, intermittent periorbital edema, and 1 superior vena caval aneurysm requiring takedown. There appears to be an increased risk of perioperative pleural effusions and chylothorax. Protein-losing enteropathy and chronic atrial arrhythmias have not been present.
Conclusions. Successful 1 ventricle repairs have been reported for morphologically small or poorly functioning pulmonary ventricles and special situations. Intermediate-term follow-up is favorable when compared with reported outcomes for the Fontan circulation.
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