Intermediate-term results of the Senning or Mustard procedures combined with the Rastelli operation for patients with discordant atrioventricular connections associated with discordant ventriculoarterial connections or double outlet right ventricle.

Intermediate-term results of the Senning or Mustard procedures combined with the Rastelli operation for patients with discordant atrioventricular connections associated with discordant ventriculoarterial connections or double outlet right ventricle.

MedLine Citation:	PMID: 17244378 Owner: NLM Status: MEDLINE
Abstract/OtherAbstract:	BACKGROUND: In patients with discordant atrioventricular and ventriculoarterial connections, anatomic repair restores the morphologically left ventricle to its role in supporting the systemic circulation. In this study, we have evaluated the outcomes in the intermediate term for this complex surgical procedure. METHODS: Between December 1984 and October 2003, 4 patients underwent an atrial switch operation concomitantly with a Rastelli operation, and 2 patients underwent an atrial switch operation and a patch-plasty of the pulmonary outflow tract for anatomic repair at a mean age of 3.3 plus or minus 2.1 years. All patients had intracardiac rerouting, connecting the morphologically left ventricle to the aorta. RESULTS: There were no hospital deaths. In 5 patients, reoperation was needed, either for baffle complications, exchange of the conduit, repair of a residual ventricular septal defect, or relief of obstruction within the left ventricular outflow tract. Death occurred in 1 patient, from cardiac failure 6 months after correction. Mean follow-up time was 6.5 plus or minus 6.4 years, with a range from 6 months to 17 years. At follow-up, 1 patient presented with moderate tricuspid insufficiency, and 1 patient with mild obstruction of the pulmonary venous pathway. The remaining 3 patients showed good left and right ventricular function, and no, or mild tricuspid and mitral insufficiency. CONCLUSIONS: Anatomic repair can be performed with low hospital mortality. Restoration of the morphologically left ventricle into the systemic circulation in patients with discordant atrioventricular and ventriculoarterial connections is a demanding approach, associated with various reoperations over time. Despite this, the approach seems to be an appropriate solution for selected patients, since the majority of the patients show good left and right ventricular function, and no, or mild tricuspid and mitral insufficiency up to 17 years after correction.

Authors:	Jürgen Hörer; Felix Haas; Julie Cleuziou; Christian Schreiber; Martin Kostolny; Manfred Vogt; Klaus Holper; Rüdiger Lange
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Publication Detail:	Type: Journal Article Date: 2007-01-23
Journal Detail:	Title: Cardiology in the young Volume: 17 ISSN: 1047-9511 ISO Abbreviation: Cardiol Young Publication Date: 2007 Apr
Date Detail:	Created Date: 2007-04-20 Completed Date: 2007-08-21 Revised Date: -
Medline Journal Info:	Nlm Unique ID: 9200019 Medline TA: Cardiol Young Country: England
Other Details:	Languages: eng Pagination: 158-65 Citation Subset: IM
Affiliation:	Department of Cardiovascular Surgery, German Heart Centre Munich at the Technical University, Munich, Germany. hoerer@dhm.mhn.de
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MeSH Terms
Descriptor/Qualifier:	Adolescent Adult Cardiac Surgical Procedures / methods* Child Child, Preschool Double Outlet Right Ventricle / diagnosis, physiopathology, surgery* Echocardiography, Doppler Follow-Up Studies Heart Atria / abnormalities, surgery Heart Catheterization Heart Ventricles / abnormalities, surgery Humans Infant Retrospective Studies Time Factors Treatment Outcome Ventricular Function / physiology

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