HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Steven P. Goldberg David N. Campbell David R. Clarke François G. Lacour-Gayet Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Goldberg, S. P. Articles by Lacour-Gayet, F. G. Search for Related Content PubMed Articles by Goldberg, S. P. Articles by Lacour-Gayet, F. G. Related Collections Congenital - acyanotic Congenital - cyanotic

Implications of incising the ventricular septum in double outlet right ventricle and in the Ross–Konno operation

The Children's Hospital Heart Institute, Denver, CO, USA

Received 28 August 2008; received in revised form 17 December 2008; accepted 19 December 2008.

^_* Corresponding author. Address: Pediatric Cardiac Surgery, The Children's Hospital, 13123 East 16th Avenue, B200, Aurora, CO 80045, USA. Tel.: +1 720 777 3376; fax: +1 720 777 7271. (Email: Lacour-Gayet.Francois{at}tchden.org).

Objective: Incision into the ventricular septum in complex biventricular repair is controversial, and has been blamed for impairing left ventricular function. This retrospective study evaluates the risk of a ventricular septal incision in patients undergoing double outlet right ventricle (DORV) repair and Ross–Konno procedure. Methods: From January 2003 to September 2007, 11 patients with DORV had a ventricular septum (VS) incision and 12 DORV patients did not. Sixteen patients had a Ross–Konno, and 16 had an isolated Ross procedure. The ventricular septal incision was made to match at least the diameter of a normal aortic annulus. In DORV, the VSD was enlarged superiorly and to the left. In the Ross–Konno, the aortic annulus was enlarged towards the septum posteriorly and to the left. Results: The median follow-up for the study is 19 months (1 month–4 years). For DORV, there were no significant differences in discharge mortality (p = 0.22), late mortality (p = 0.48), or late mortality plus heart transplant (p = 0.093). Although patients with DORV and VSD enlargement have a more complex postoperative course, there were no differences in ECMO use (p = 0.093), occurrence of permanent AV block (p = 0.55), left ventricular ejection fraction (LVEF) (p = 0.40), or shortening fraction (LVSF) (p = 0.50). Similarly, for the Ross–Konno there were no significant differences in discharge mortality (p = 0.30), late mortality (p = NS), LVEF ( p = 0.90) and LVSF (p = 0.52) compared to the Ross, even though the Ross–Konno patients were significantly younger (p < 0.0001). Conclusion: Making a ventricular septal incision in DORV repair and in the Ross–Konno operation does not increase mortality and does not impair the LV function. The restriction of the VSD remains an important issue in the management of complex DORV. These encouraging results need to be confirmed by larger series.

Key Words: Double outlet right ventricle • Ventricular septal defect • Ross–Konno