Document Detail

Biventricular repair for right atrial isomerism.
MedLine Citation:
PMID:  16631677     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Biventricular repair is often difficult to accomplish in patients with right atrial isomerism because of complex anomalous structures. METHODS: Ten patients with right atrial isomerism underwent biventricular repair. Their ages ranged from 15 months to 21 years. The follow-up period ranged from 1 month to 21 years. The Fontan procedure was unsuitable in 7 patients. The atrioventricular valves were separated in 5 patients and common in 5. One patient who had severe right-sided atrioventricular valvular regurgitation required concomitant prosthetic valve replacement. Another patient with a hypoplastic intraventricular septum underwent ventricular septation. Nine patients had two balanced ventricles. A ventricular septal defect was enlarged for rerouting in 3 patients. All patients had anomalous venoatrial connections and required intra-atrial baffle rerouting. One with major aortopulmonary collateral arteries underwent staged unifocalization. Three had extracardiac conduit repair. The outcomes were compared with 97 patients who underwent the Fontan procedure. RESULTS: There were 3 early deaths and 1 late death. Six survivors are in New York Heart Association functional class I or II. Two are free from medications. Two required reoperation owing to infection or prosthetic valve failure. At 1 year, cardiac index and systemic venous pressure were 3.2 +/- 0.9 L.min(-1).m(-2) and 6.6 +/- 1.6 mm Hg, respectively. There were no significant differences in survival, freedom from arrhythmia, freedom from reoperation, or exercise tolerance between biventricular repair and the Fontan procedure. CONCLUSIONS: Biventricular repair provided good long-term outcomes in patients with right atrial isomerism. In selected circumstances, biventricular repair is an acceptable alternative to the Fontan procedure.
Masahiro Koh; Toshikatsu Yagihara; Hideki Uemura; Koji Kagisaki; Ikuo Hagino; Toru Ishizaka; Soichiro Kitamura
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  81     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2006 May 
Date Detail:
Created Date:  2006-04-24     Completed Date:  2006-05-25     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1808-16; discussion 1816     Citation Subset:  AIM; IM    
Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan.
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MeSH Terms
Abnormalities, Multiple / surgery*
Arrhythmias, Cardiac / epidemiology
Cardiac Surgical Procedures / methods*
Child, Preschool
Exercise Tolerance
Fontan Procedure
Heart Atria / abnormalities*
Heart Catheterization
Heart Ventricles / abnormalities*
Pulmonary Artery / surgery
Pulmonary Veins / abnormalities
Viscera / abnormalities

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