Biventricular Repair for Right Atrial Isomerism

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Biventricular Repair for Right Atrial Isomerism Masahiro Koh, MD, Toshikatsu Yagihara, MD, Hideki Uemura, MD, Koji Kagisaki, MD, Ikuo Hagino, MD, Toru Ishizaka, MD, Soichiro Kitamura, MD The Annals of Thoracic Surgery Volume 81, Issue 5, Pages 1808-1816 (May 2006) DOI: 10.1016/j.athoracsur.2005.12.008 Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Number of cases of definitive repair for right atrial isomerism. (Open bars = survived; shaded bars = hospital death; pt = patient.) The Annals of Thoracic Surgery 2006 81, 1808-1816DOI: (10.1016/j.athoracsur.2005.12.008) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Patients’ clinical data. (Ao from RV = solitary outlet of the aorta arising from the right ventricle; AV valve = atrioventricular valve; 2AVV = separated atrioventricular valves; CAVV = common atrioventricular valve; CAVVR = common atrioventricular valvular regurgitation; DORV = double outlet right ventricle; IVC = inferior vena cava; IVS = interventricular septum; MAPCAs = major aortopulmonary collateral arteries; PA = pulmonary atresia or pulmonary artery; PAP = pulmonary arterial pressure; PS = pulmonary stenosis; PV connection = pulmonary venous connection; PVR = pulmonary vascular resistance; P & W = peel and wrap; SP shunt = systemic-pulmonary artery shunt; SVC = superior vena cava; TAPVC = total anomalous pulmonary venous connection; TR = tricuspid valvular regurgitation [right-sided AV valvular regurgitation]; UF = unifocalization; VA connection = ventriculoarterial connection; VSD = ventricular septal defect.) The Annals of Thoracic Surgery 2006 81, 1808-1816DOI: (10.1016/j.athoracsur.2005.12.008) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Operative techniques and outcomes. (2-patch = two-patch repair; AT = atrial tachyarrhythmia; AV valve = atrioventricular valve; ECP = endocardial cushion prosthesis; ECR = extracardiac conduit repair; IE = infective endocarditis; MR = mitral valvular regurgitation (left-sided AV valvular regurgitation); NYHA = New York Heart Association functional class; PA = pulmonary artery; PVF = prosthetic valve failure; Reop = reoperation; RV = right ventricle; TAP = transannular patching; TAPVC = total anomalous pulmonary venous connection; TVR = tricuspid valve replacement; VSD = ventricular septal defect.) The Annals of Thoracic Surgery 2006 81, 1808-1816DOI: (10.1016/j.athoracsur.2005.12.008) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Kaplan-Meier freedom-from-event curves. The solid lines represent patients with biventricular repair (BVR), and the dotted lines represent patients with the Fontan procedure. (A) Overall survival. (B) Freedom from arrhythmia. (C) Freedom from reoperation. The Annals of Thoracic Surgery 2006 81, 1808-1816DOI: (10.1016/j.athoracsur.2005.12.008) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Comparison of catheterization data. The empty circles represent patients with the Fontan procedure, and the full circles represent patients with biventricular repair (BVR). (A) One year after the surgery. (B) Ten years after the surgery. Bars represent mean ± SD. The Annals of Thoracic Surgery 2006 81, 1808-1816DOI: (10.1016/j.athoracsur.2005.12.008) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Comparison of exercise tolerance. The empty circles represent patients with the Fontan procedure, and the full circles represent patients with biventricular repair. Bars represent mean ± SD. (VO2= oxygen consumption.) The Annals of Thoracic Surgery 2006 81, 1808-1816DOI: (10.1016/j.athoracsur.2005.12.008) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 7 Venn diagram depicting associated anomalous structures in right atrial isomerism. Numbers without underlining represent biventricular repair (BVR), and numbers with underlining represent the Fontan procedure. (2AVV = separated atrioventricular valves.) The Annals of Thoracic Surgery 2006 81, 1808-1816DOI: (10.1016/j.athoracsur.2005.12.008) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions