Ann Thorac Surg 2005;79:1824
© 2005 The Society of Thoracic Surgeons
Correspondence
Optimal Surgical Repair for Double Outlet Right Ventricle and Intact Ventricular Septum: Reply
Carlo Pace Napoleone, MD
Department of Pediatric Cardiac Surgery, S. Orsola-Malpighi Hospital, Via Massarenti, 9, Bologna 40138, Italy
pace{at}orsola-malpighi.med.unibo.it
To the Editor:
We would like to thank Dr Troise and associates for their thoughts concerning our recent report [1] on a patient with double outlet right ventricle with intact ventricular septum, and we do completely agree that no definitive statement can be drawn about the optimal surgical treatment of this rare anatomic entity. However, we speculated that a nonhypertensive left ventricular cavity may be a more acceptable compromise, thus possibly avoiding late complications such as arrhythmias or systemic ventricular dysfunction. This is the same philosophy that leads current era pediatric cardiac surgeons and cardiologists to try to decompress the right ventricle in patients with pulmonary atresia and intact septum (PAIVS), even in cases with rather small right ventricles not likely to increase their volume after anterograde flow is provided. By choosing to completely open the left ventricular cavity into the common atrium, we aimed to reduce the risk for major long-term complications, something that has nothing to do with early or even medium-term survival. Indeed, some patients with PAIVS and a right ventricular dependent coronary circulation may survive several decades with a highly hypertensive right ventricle, but increased mortality and morbidity have been described in such cases. Even if we are aware that there is no way to predict the long-term outcome of any kind of mitral valve surgery in this rare condition, it is our opinion that the only potential clue in the surgical decision-making of this malformation may come from the past experience of patients with PAIVS. Only time and a careful follow-up will perhaps provide an answer.
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References
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- Napoleone CP, Formigari R, Chiappini B, Frascaroli G, Gargiulo G. Surgical management of double outlet right ventricle and intact ventricular septum. Ann Thorac Surg. 2003;75:586–587[Abstract/Free Full Text]
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