J Korean Med Sci.  2010 Mar;25(3):374-379. 10.3346/jkms.2010.25.3.374.

Surgical Management of Left Ventricular Outflow Tract Obstruction after Biventricular Repair of Double Outlet Right Ventricle

• Kim CY
• Kim WH
• Kwak JG
• Jang WS
• Lee CH
• Kim DJ
• Lim C
• Chang WI

• KMID: 1778031
• DOI: http://doi.org/10.3346/jkms.2010.25.3.374

Abstract

Regardless of the preoperative morphology and the type of operation, left ventricular outflow tract obstruction (LVOTO) after biventricular repair of double outlet right ventricle (DORV) may develop. This report presents our 10-yr experience with surgical management of LVOTO after biventricular repair of DORV. Between 1996 and 2006, 15 patients underwent reoperation for subaortic stenosis after biventricular repair of DORV. The mean age at biventricular repair was 23.3+/-18.3 months (1.1-64.2). Biventricular repairs included tunnel constructions from the left ventricle to the aorta in 14 cases and an arterial switch operation in one. The mean left ventricle-to-aorta peak pressure gradient was 54.0+/-37.7 mmHg (15-140) after a mean follow-up of 9.5+/-6.3 yr. We performed extended septoplasty in nine patients and fibromuscular resection in six. There were no early or late mortality. There was one heart block and one aortic valve injury after an extended septoplasty, and two and one after a fibromuscular resection. No patient required reoperation for recurrent subaortic stenosis. The mean pressure gradient was 11.2+/-11.4 mmHg (0-34) after a mean follow-up of 5.6+/-2.7 yr. Extended septoplasty is a safe and effective method for the treatment of subaortic stenosis, especially in cases with a long-tunnel shaped LVOTO.

Keyword

DORV; Aortic Stenosis, Subvalvular

MeSH Terms

Blood Pressure/physiology
Child, Preschool
Double Outlet Right Ventricle/pathology/*surgery
Female
Heart Defects, Congenital/pathology/surgery
Humans
Infant
Male
Postoperative Complications/*surgery
Reoperation
Retrospective Studies
Treatment Outcome
*Ventricular Outflow Obstruction/etiology/surgery

Figure

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  Fig. 1 Illustrations showing the extended septoplasty. (A) A right ventriculotomy (dotted curve) is made in the right ventricular outflow tract. (B) A longitudinal septal incision is made at the previous patch, and extended toward the apex, beyond the previous patch, into the interventricular septum, and toward the aortic valve, into the conal septum avoiding direct injury to the aortic valve. (C) The new patch is then trimmed along the extended septal incision, and inserted to secure a redundant pathway in the left ventricular outflow tract.

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  Fig. 2 Photograph, taken after the extended septal incision and some interrupted sutures for anchoring a new septal patch, showing the previous patch (arrow) and the septal incision (asterisk).

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  Fig. 3 Angiogram showing the long tunnel-shaped left ventricular outflow tract obstruction after biventricular repair of DORV.

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