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Ann Thorac Surg 2005;80:2293-2300
© 2005 The Society of Thoracic Surgeons

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Original article: Cardiovascular

One and One-Half Ventricle Repair: Results and Concerns

Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India

Accepted for publication May 17, 2005.

^_* Address correspondence to Dr Chowdhury, Department of Cardiothoracic Surgery, All India Institute of Medical Sciences, New Delhi, 110029, India (Email: ujjwalchow{at}rediffmail.com).

BACKGROUND: The study was designed to assess the long-term results of one and one-half ventricular repair on systemic and pulmonary circulation, right ventricular growth and function, and the prevalence of arrhythmias.

METHODS: Eighty-four patients undergoing one and one-half ventricular repair between January 1990 and December 2003 were studied. Age was 4 to 504 months (mean, 47.9 ± 57.3 months). Sixty-nine survivors underwent serial echocardiography, radionuclide studies, cardiac magnetic resonance imaging, and cardiac catheterization.

RESULTS: Operative and late mortality were 10.7% and 8%, respectively. Perioperative and postoperative supraventricular arrhythmias were observed in 14.3% and 15.9% of patients, respectively. Risk factors for supraventricular arrhythmias included systemic ventricular dysfunction, heterotaxy syndrome, and Ebstein's anomaly. Mean late postoperative superior vena caval pressure was 14.2 ± 1.52 mm Hg and right atrial pressure was 6.6 ± 0.74 mm Hg. At a median follow-up of 87 months, actuarial survival was 81.9% ± 0.04%, and 89.8% were in New York Heart Association class I or II. Serial cine–magnetic resonance imaging demonstrated significant growth of tricuspid valve and right ventricular cavity in 45% of patients.

CONCLUSIONS: One and one-half ventricular repair can be performed with an acceptable risk. The operation maintains a low pressure in the inferior vena caval tributaries, and reverses the Fontan paradox. Patients with tripartite right ventricles demonstrated a tendency toward enlargement of the pulmonary ventricular chamber commensurable with somatic growth.

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