Late Assessment After Biventricular Repair for Isomerism Heart

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Presentation transcript:

Late Assessment After Biventricular Repair for Isomerism Heart Hajime Ichikawa, MD, Yoshiki Sawa, MD, Norihide Fukushima, MD, Toru Ishizaka, MD, Shigemitsu Iwai, MD, Haruhiko Kondo, MD, Hikaru Matsuda, MD The Annals of Thoracic Surgery Volume 80, Issue 1, Pages 50-55 (July 2005) DOI: 10.1016/j.athoracsur.2005.01.065 Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Various venous drainage patterns of the patients: left isomerism = 7, right isomerism = 3. (PV = pulmonary vein.) The Annals of Thoracic Surgery 2005 80, 50-55DOI: (10.1016/j.athoracsur.2005.01.065) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Percent normal of right ventricular end-diastolic volume index(%RVEDVI) was plotted over percent of normal of left ventricular end-diastolic volume index (%LVEDVI). The arrows indicate the patient with high pulmonary vascular resistance (PVR > 3.0). Boxes = medium flow [1.0 < Qp/Qs < 1.5]; diamonds = low flow [Qp/Qs < 1.0]; triangles = high flow [1.5 < Qp/Qs]. (Qp/Qs = pulmonary to systemic blood flow ratio.) The Annals of Thoracic Surgery 2005 80, 50-55DOI: (10.1016/j.athoracsur.2005.01.065) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 The method for atrioventricular septal defect repair with autopericardial “winged” patch (Kawashima). The Annals of Thoracic Surgery 2005 80, 50-55DOI: (10.1016/j.athoracsur.2005.01.065) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 (A) The two left (L) isomerism cases with simple atrial septation and complete atrioventricular septal defect (AVSD) are shown. The case on the left required interventricular tunnel repair for double-outlet right ventricle. (B) The two cases with left (L) isomerism with complete AVSD and complex atrial septation are shown. These two cases also required extensive subaortic conus resection and complex interventricular baffles. (C) The three left (L) isomerism cases with two atrioventricular valves are shown. The first two cases also required a complex interventricular tunnel. The third case had no VSD but all the cavae and pulmonary veins were returning to the left-sided atrium; only the coronary sinus was draining in the right-sided atrium. (D) The three right (R) isomerism cases are shown. All cases required a complex atrial baffle and interventricular baffle. One patient required a valved pericardial right ventricle to pulmonary arterial conduit.(Ao = aorta; PA = pulmonary artery; PV = pulmonary vein.) The Annals of Thoracic Surgery 2005 80, 50-55DOI: (10.1016/j.athoracsur.2005.01.065) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 The actuarial survival of the patients with biventricular repair (n = 10; open circles) and univentricular repair (Fontan-type repair; n = 25; open boxes) is shown. Solid boxes = patient died. The Annals of Thoracic Surgery 2005 80, 50-55DOI: (10.1016/j.athoracsur.2005.01.065) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 (A) The complicated intra-atrial baffle at the biventricular repair. (B) The venous angiogram (left) and its schematic presentation (right) 10 years after the biventricular repair. The intra-atrial baffle shows multiple stenosis (black arrows). (C) The angiogram (left) and its schematic presentation (right) after the placement of two stents in the intra-atrial baffle. The white arrows indicate the enlargement of the baffle by two stents. (HV = hepatic vein; MV = mitral valve; SVC = superior vena cava; TV = tricuspid valve.) The Annals of Thoracic Surgery 2005 80, 50-55DOI: (10.1016/j.athoracsur.2005.01.065) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions