Biventricular conversion for complex congenital heart defects palliated towards single-ventricle repair_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIShoujun , CHENQiuming , HUAZhongdong , ZHANGHao , WANGXu , YANFuxia , LIUJinping , GAOHuawei , MAKai , ZHANGSen , QILei ,  HUShengshou

Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease, Fu Wai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100037, P.R.China;

Corresponding author：

HUShengshou, Email: shengshouhu@yahoo.com

Keywords：

Complex congenital heart defects; Glenn shunt; single ventricle; biventricular repair

DOI：

10.7507/1007-4848.201607049

Video：

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Objective Complex congenital heart defects are sometimes treated by Fontan palliation for various reasons. However, the middle- and long-term prognosis of single-ventricle repair is worse than that of two-ventricle repair. In this study we reported the results of biventricular conversion in these challenging patients initially palliated towards single-ventricle repair. Methods Eight patients underwent biventricular repair conversion from prior bidirectional Glenn shunt palliation in our hospital between October 2013 and March 2016. The median age in bidirectional Glenn shunt was 2.6 years (range, 1.0 to 5.9 years) and in biventricular repair conversion was 6.6 years (range, 4.5 to 11.1 years). Three patients suffered complete transposition of great arteries combined with ventricular septal defect and left ventricular outflow tract obstruction, three double outlet right ventricle and non-committed ventricular septal defect combined with pulmonary stenosis or atresia, one double outlet right ventricle combined with complete ativentricular septal defect and pulmonary stenosis and one Tetralogy of Fallot. Results Bidirectional Glenn shunt was taken down and superior vena cava was reconnected to the right atrium in all patients. Mean cardiopulmonary bypass and aortic cross-clamp time was 275.6±107.1 min and 165.9±63.6 min, respectively. Mean length of hospital stay and ICU stay were 33.6±23.0 d and 20.3±21.0 d, respectively. At a mean follow-up of 1.4±0.7 years, there was no mortality and reoperation. No patients presented with sinoatrial node dysfunction and superior vena cava anastomotic stenosis. According to the New York Heart Association (NYHA) Functional Classification, all patients were classified asⅠ-Ⅱ. Conclusion Biventricular repair conversion can be safely performed with favorable mortality and morbidity in specific patients palliated towards single-ventricle repair. Further follow-up is needed to investigate the long-term outcomes.

Citation： LIShoujun, CHENQiuming, HUAZhongdong, ZHANGHao, WANGXu, YANFuxia, LIUJinping, GAOHuawei, MAKai, ZHANGSen, QILei, HUShengshou. Biventricular conversion for complex congenital heart defects palliated towards single-ventricle repair. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(2): 138-142. doi: 10.7507/1007-4848.201607049 Copy

1.	Rogers LS, Glatz AC, Ravishankar C, et al. 18 years of the Fontan operation at a single institution: results from 771 consecutive patients. J Am Coll Cardiol, 2012, 60(11): 1018-1025.
2.	Jonas RA. Fontan or septation: When I Abandon septation in complex lesions with two ventricles. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2009, 12(1): 94-98.
3.	Hoashi T, Bove EL, Devaney EJ, et al. Outcomes of 1½- or 2-ventricle conversion for patients initially treated with single-ventricle palliation. J Thorac Cardiovasc Surg, 2011, 141(2): 419-424.
4.	Leval MRD, Deanfield JE. Four decades of Fontan palliation. Nat Rev Cardiol, 2010, 7(9): 520-527.
5.	Lacour-Gayet F. Biventricular repair of double outlet right ventricle with noncommitted ventricular septal defect. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2002, 5(1): 163-172.
6.	d'Udekem Y, Iyengar AJ, Galati JC, et al. Redefining expectations of long-term survival after the Fontan procedure: twenty-five years of follow-up from the entire population of Australia and New Zealand. Circulation, 2014, 130(11 Suppl 1): S32-S38.
7.	Boechat MI, Ratib O, Williams PL, et al. Cardiac MR imaging and MR angiography for assessment of complex tetralogy of Fallot and pulmonary atresia. Radiographics, 2005, 25(6): 1535-1546.
8.	Bharucha T, Roman KS, Anderson RH, et al. Impact of multiplanar review of three-dimensional echocardiographic data on management of congenital heart disease. Ann Thorac Surg, 2008, 86(3): 875-881.
9.	Farooqi KM, Nielsen JC, Uppu SC, et al. Use of 3-dimensional printing to demonstrate complex intracardiac relationships in double-outlet right ventricle for surgical planning. Circ Cardiovasc Imaging, 2015, 8(5): 887-897.
10.	Farooqi KM, Uppu SC, Nguyen K, et al. Application of virtual three-dimensional models for simultaneous visualization of intracardiac anatomic relationships in double outlet right ventricle. Pediatr Cardiol, 2015, 37(1): 1-9.
11.	花中东, 杨新令, 刘凯飏, 等. 应用 3D 打印技术改进远离型右室双出口的外科治疗结果. 中国胸心血管外科临床杂志, 2016, 23(6): 532-536.
12.	Hu SS, Liu ZG, Li SJ, et al. Strategy for biventricular outflow tract reconstruction: Rastelli, REV, or Nikaidoh procedure? J Thorac Cardiovasc Surg, 2008, 135(2): 331-338.
13.	Hu S, Xie Y, Li S, et al. Double-root translocation for double-outlet right ventricle with noncommitted ventricular septal defect or double-outlet right ventricle with subpulmonary ventricular septal defect associated with pulmonary stenosis: an optimized solution. Ann Thorac Surg, 2010, 89(5): 1360-1365.
14.	胡盛寿, 李守军, 闫军, 等. 解剖性双心室流出道重建技术: 双根部调转手术. 中华胸心血管外科杂志, 2014, 30(9): 526-531.
15.	Li S, Ma K, Hu S, et al. Biventricular repair for double outlet right ventricle with non-committed ventricular septal defect. Eur J Cardiothorac Surg, 2015, 48(4): 3-8.
16.	Li S, Ma K, Hu S, et al. Surgical outcomes of 380 patients with double outlet right ventricle who underwent biventricular repair. J Thorac Cardiovasc Surg, 2014, 148(3): 817-824.
17.	Kottayil BP, Sunil GS, Kappanayil M, et al. Two-ventricle repair for complex congenital heart defects palliated towards single-ventricle repair. Interact Cardiovasc Thorac Surg, 2013, 18(3): 266-271.
18.	Nathan M, Liu H, Pigula FA, et al. Biventricular conversion after single-ventricle palliation in unbalanced atrioventricular canal defects. Ann Thorac Surg, 2013, 95(6): 2095-2096.
19.	Bruckheimer E, Bulbul ZR, Hellenbrand WE, et al. Takedown of Glenn shunts in adults with congenital heart disease with polytetrafluoroethylene grafts: technique and long-term follow-up. J Thorac Cardiovasc Surg, 1997, 113(3): 607-608.
20.	Baird CW, Myers PO, Borisuk M, et al. Takedown of cavopulmonary shunt at biventricular repair. J Thorac Cardiovasc Surg, 2014, 148(4): 1506-1511.

1. Rogers LS, Glatz AC, Ravishankar C, et al. 18 years of the Fontan operation at a single institution: results from 771 consecutive patients. J Am Coll Cardiol, 2012, 60(11): 1018-1025.
2. Jonas RA. Fontan or septation: When I Abandon septation in complex lesions with two ventricles. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2009, 12(1): 94-98.
3. Hoashi T, Bove EL, Devaney EJ, et al. Outcomes of 1½- or 2-ventricle conversion for patients initially treated with single-ventricle palliation. J Thorac Cardiovasc Surg, 2011, 141(2): 419-424.
4. Leval MRD, Deanfield JE. Four decades of Fontan palliation. Nat Rev Cardiol, 2010, 7(9): 520-527.
5. Lacour-Gayet F. Biventricular repair of double outlet right ventricle with noncommitted ventricular septal defect. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2002, 5(1): 163-172.
6. d'Udekem Y, Iyengar AJ, Galati JC, et al. Redefining expectations of long-term survival after the Fontan procedure: twenty-five years of follow-up from the entire population of Australia and New Zealand. Circulation, 2014, 130(11 Suppl 1): S32-S38.
7. Boechat MI, Ratib O, Williams PL, et al. Cardiac MR imaging and MR angiography for assessment of complex tetralogy of Fallot and pulmonary atresia. Radiographics, 2005, 25(6): 1535-1546.
8. Bharucha T, Roman KS, Anderson RH, et al. Impact of multiplanar review of three-dimensional echocardiographic data on management of congenital heart disease. Ann Thorac Surg, 2008, 86(3): 875-881.
9. Farooqi KM, Nielsen JC, Uppu SC, et al. Use of 3-dimensional printing to demonstrate complex intracardiac relationships in double-outlet right ventricle for surgical planning. Circ Cardiovasc Imaging, 2015, 8(5): 887-897.
10. Farooqi KM, Uppu SC, Nguyen K, et al. Application of virtual three-dimensional models for simultaneous visualization of intracardiac anatomic relationships in double outlet right ventricle. Pediatr Cardiol, 2015, 37(1): 1-9.
11. 花中东, 杨新令, 刘凯飏, 等. 应用 3D 打印技术改进远离型右室双出口的外科治疗结果. 中国胸心血管外科临床杂志, 2016, 23(6): 532-536.
12. Hu SS, Liu ZG, Li SJ, et al. Strategy for biventricular outflow tract reconstruction: Rastelli, REV, or Nikaidoh procedure? J Thorac Cardiovasc Surg, 2008, 135(2): 331-338.
13. Hu S, Xie Y, Li S, et al. Double-root translocation for double-outlet right ventricle with noncommitted ventricular septal defect or double-outlet right ventricle with subpulmonary ventricular septal defect associated with pulmonary stenosis: an optimized solution. Ann Thorac Surg, 2010, 89(5): 1360-1365.
14. 胡盛寿, 李守军, 闫军, 等. 解剖性双心室流出道重建技术: 双根部调转手术. 中华胸心血管外科杂志, 2014, 30(9): 526-531.
15. Li S, Ma K, Hu S, et al. Biventricular repair for double outlet right ventricle with non-committed ventricular septal defect. Eur J Cardiothorac Surg, 2015, 48(4): 3-8.
16. Li S, Ma K, Hu S, et al. Surgical outcomes of 380 patients with double outlet right ventricle who underwent biventricular repair. J Thorac Cardiovasc Surg, 2014, 148(3): 817-824.
17. Kottayil BP, Sunil GS, Kappanayil M, et al. Two-ventricle repair for complex congenital heart defects palliated towards single-ventricle repair. Interact Cardiovasc Thorac Surg, 2013, 18(3): 266-271.
18. Nathan M, Liu H, Pigula FA, et al. Biventricular conversion after single-ventricle palliation in unbalanced atrioventricular canal defects. Ann Thorac Surg, 2013, 95(6): 2095-2096.
19. Bruckheimer E, Bulbul ZR, Hellenbrand WE, et al. Takedown of Glenn shunts in adults with congenital heart disease with polytetrafluoroethylene grafts: technique and long-term follow-up. J Thorac Cardiovasc Surg, 1997, 113(3): 607-608.
20. Baird CW, Myers PO, Borisuk M, et al. Takedown of cavopulmonary shunt at biventricular repair. J Thorac Cardiovasc Surg, 2014, 148(4): 1506-1511.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Biventricular conversion for complex congenital heart defects palliated towards single-ventricle repair

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