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J Thorac Cardiovasc Surg 2007;134:1381
© 2007 The American Association for Thoracic Surgery

Letter to the Editor

Reply to the Editor

Luis G. Quinonez, MD

University of Alberta Hospital, Edmonton, Alberta, Canada

My colleagues and I thank Dr Chauvaud for his comments and acknowledge the contribution of his team to the surgical treatment of Ebstein anomaly.

The use of the term "1.5-ventricle" was a semantic choice used to represent an operation, rather than a quantitative or physiologic descriptor. It is widely understood that diversion of blood flow by a bidirectional cavopulmonary shunt (BCPS) varies from one third to one half of the systemic venous return, depending on the patient’s age.

To decide when to construct a BCPS, the surgeon has to use his or her judgment and experience and take into consideration the patient’s clinical condition, echocardiographic data, magnetic resonance imaging data (if available), preoperative and intraoperative hemodynamic data, and the intraoperative morphologic appearance of the right ventricle. The status of the left ventricle is also very important. Our series is too limited to advise as to the specific indications of a BCPS in Ebstein anomaly, yet with further experience and follow-up these will become apparent. It is our impression that it is only needed in a few selected cases.

The term "failing right ventricle" is deliberately general. It may describe a right ventricle that cannot sustain the circulation after cardiopulmonary bypass; it may describe a right ventricle that is severely dysfunctional or dilated on echocardiography, magnetic resonance imaging, or intraoperative inspection; or it may describe a right ventricle with a large atrialized component, a thin wall, and paradoxical septal motion, as pointed out by Dr Chauvaud. In any of these circumstances, the patient may be free of symptoms. The underlying difficulty arises in the precise quantification of right ventricular function by the currently available methods. We are exploring the use of magnetic resonance imaging to better describe and quantitate the morphology and function of the right ventricle.


Related Article

Surgery of Ebstein anomaly
S. Chauvaud
J. Thorac. Cardiovasc. Surg. 2007 134: 1381. [Extract] [Full Text] [PDF]




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