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Ann Thorac Surg 1999;68:555
© 1999 The Society of Thoracic Surgeons

Invited Commentary

Thomas P. Graham, Jr, MDa

a Division of Pediatric Cardiology Vanderbilt University School of Medicine Room D-2220 MCN Nashville, TN 37232-2572, USA

Invited commentary

There are a growing number of investigations that indicate that some patients with relatively small left ventricles can achieve a significant postsurgical increase in volume and maintain a perfectly adequate two-ventricular circulation after successful repair. These authors have made a number of important observations indicating that their patients with coarctation, normal mitral valve diameters, relatively small left ventricular volumes, small aortic outflow tracts, or aortic roots can be treated with simple coarctation surgery and do not need consideration for a univentricular type of approach. These patients frequently have significant left-to-right shunting at the atrial level preoperatively largely due to diastolic dysfunction secondary to an increased afterload. They rarely, if ever, need ASD surgery, as these defects virtually always represent a dilated patent foramen ovale that gets smaller in size and eventually closes spontaneously after successful coarctation repair. It is incumbent on the cardiologist to make a number of echocardiographic measurements and to use all information possible to determine if a biventricular repair is feasible in this as well as more complex cardiac conditions with small left ventricles. This manuscript helps in defining those patients with a small left ventricle preoperatively in whom a two-ventricle circulation is possible.


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Ann. Thorac. Surg. 1999 68: 549-555. [Abstract] [Full Text] [PDF]



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