Double-Root Translocation for Double-Outlet Right Ventricle With Noncommitted Ventricular Septal Defect or Double-Outlet Right Ventricle With Subpulmonary.

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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 Shengshou Hu, MD, Yongquan Xie, MD, Shoujun Li, MD, Xu Wang, MD, Fuxia Yan, MD, Yongqing Li, MD, Zhongdong Hua, MD, Yan Li, MD The Annals of Thoracic Surgery Volume 89, Issue 5, Pages 1360-1365 (May 2010) DOI: 10.1016/j.athoracsur.2010.02.007 Copyright © 2010 The Society of Thoxracic Surgeons Terms and Conditions

Fig 1 The anatomy of double-outlet right ventricle with noncommitted ventricular septal defect (VSD) associated with pulmonary stenosis features with (1) a VSD distant from both aortic and pulmonary annulus by a length superior to an aortic diameter; (2) both great vessels arising 200% from the right ventricle; (3) a double conus; and (4) pulmonary stenosis with hypoplasia trunk. The dashed line illustrates the area of mobilization of aortic and pulmonary root. The ventricular septal tissue of the upper edge of the VSD was reserved as the ventricular septum of the neo–left ventricular outflow tract for after reconnection to aortic root. (Ao = aorta; LV = left ventricle; MV = mitral valve; PA = pulmonary artery; RV = right ventricle.) The Annals of Thoracic Surgery 2010 89, 1360-1365DOI: (10.1016/j.athoracsur.2010.02.007) Copyright © 2010 The Society of Thoxracic Surgeons Terms and Conditions

Fig 2 After complete mobilization of aortic and pulmonary root, two new orifices of left and right ventricular outflow tract were exposed for after the reconnection. The left coronary ostium was harvested and prepared for reimplantation at a favorable site in the aortic sinus. The ventricular septal defect was simply repaired with a Dacron patch. The aorta was transected for a subsequent Lecompte maneuver. (Ao = aorta; MV = mitral valve; PA = pulmonary artery.) The Annals of Thoracic Surgery 2010 89, 1360-1365DOI: (10.1016/j.athoracsur.2010.02.007) Copyright © 2010 The Society of Thoxracic Surgeons Terms and Conditions

Fig 3 Reconstruction of the left ventriculoaorta and right ventriculopulmonary trunk continuity. The aortic roots were connected to the neo-orifice of the left ventricular outflow tract, followed with left coronary artery reimplantation. After the Lecompte maneuver, a monocusp bovine jugular vein patch or a homograft pulmonary patch was tailored to reconstruct a neopulmonary root and connected to the reshaped orifice of the right ventricular outflow tract. (Ao = aorta; LV = left ventricle; PA = pulmonary artery; RV = right ventricle.) The Annals of Thoracic Surgery 2010 89, 1360-1365DOI: (10.1016/j.athoracsur.2010.02.007) Copyright © 2010 The Society of Thoxracic Surgeons Terms and Conditions

Fig 4 Echocardiograms of a patient with double-outlet right ventricle with noncommitted ventricular septal defect (DORVncVSD) associated with pulmonary stenosis (PS) before and after double-root translocation (DRT). (A) Preoperative parasternal long-axis view. The right ventricle (RV) gives rise to the pulmonary artery (PA), with valvular and subvalvular stenosis. (B) The apical double outlets view preoperatively. The RV gives rise to both arteries, double conus. Only a very little portion of the VSD could be seen on this view. (C) Apical four-chamber view shows a large inlet VSD. (D) Postoperative parasternal long-axis view shows completely normal morphology of the left ventricular outflow tract (LVOT) after the DRT procedure. (Ao = aorta; LA = left atrium; LV = left ventricle; PV = pulmonary vein; RA = right atrium.) The Annals of Thoracic Surgery 2010 89, 1360-1365DOI: (10.1016/j.athoracsur.2010.02.007) Copyright © 2010 The Society of Thoxracic Surgeons Terms and Conditions