The Journal of Thoracic and Cardiovascular Surgery, Vol 79, 202-210, Copyright © 1980 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
A surgical approach for S,L,L single ventricle incorporating total right atrium--pulmonary artery diversion
RJ Moreno-Cabral, DC Miller, PE Oyer, EB Stinson, BA Reitz and NE Shumway
Patients with single ventricle and unfavorable anatomy for partitioning
procedures have been considered inoperable. Such was the case in two
patients with single ventricle and subaortic inverted (hypoplastic)
infundibulum associated with subaortic obstruction and levo- transposition
of the great vessels (S,L,L). Both had undergone pulmonary artery banding
in infancy and presented 11 and 14 years later, cyanotic and severely
incapacitated. Both patients were treated surgically by resection of the
subaortic obstruction, patch closure of the right artrioventricular valve,
closure of the proximal pulmonary artery, and diversion of systemic venous
flow through a xenograft valved conduit from the right atrium to the distal
pulmonary artery. Early postoperative complications included atrial
dysrhythmias and right-sided congestion. The first patient, who had massive
cardiomegaly and complete heart block preoperatively, developed congestive
failure 20 months postoperatively. The second patient has an excellent
functional result and is leading a normal life 1 years after operation.
This procedure may be of value for patients with single ventricle in whom
corrective ventricular septation is considered too risky or technically
unfeasible.
