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Related Experiment Videos

Left atrial appendage insertion for right ventricular outflow tract reconstruction.

R Aeba1, T Katogi, I Kashima

  • 1Department of Pediatrics, Keio University, Tokyo, Japan. aeba@mc.med.keio.ac.jp

The Annals of Thoracic Surgery
|March 10, 2001
PubMed
Summary

Left atrial appendage (LAA) insertion offers a safe and effective method for right ventricular outflow tract (RVOT) reconstruction, avoiding extracardiac conduits and reducing complications in pediatric cardiac surgery.

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Area of Science:

  • Cardiovascular Surgery
  • Pediatric Cardiology
  • Congenital Heart Disease

Background:

  • The left atrial appendage (LAA) presents a potential alternative to the pulmonary arterial wall for right ventricular outflow tract (RVOT) reconstruction.
  • This approach aims to avoid the need for an extracardiac conduit in complex congenital heart surgeries.

Purpose of the Study:

  • To evaluate the efficacy and safety of using the LAA for RVOT reconstruction in pediatric patients.
  • To assess the feasibility of LAA insertion as an alternative to traditional methods.

Main Methods:

  • Five pediatric patients with pulmonary atresia or severe stenosis underwent RVOT reconstruction utilizing LAA insertion.
  • Surgical procedures addressed conditions including tetralogy of Fallot, double-outlet right ventricle, and transposition of the great arteries.

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  • The LAA was inserted to achieve a posterior RVOT wall width of at least 20 mm, with anterior augmentation using a pericardial patch.

    • Main Results:

    • No early or late deaths occurred; no major complications such as arrhythmias, thrombo-embolic events, or endocarditis were reported.
    • The post-repair right ventricular-to-systemic arterial pressure ratio was 0.61 ± 0.26.
    • Color Doppler confirmed non-obstructive, non-turbulent flow in the reconstructed RVOT, with no observed thrombus or pseudoneointimal formation.

    Conclusions:

    • Left atrial appendage insertion into the RVOT is an effective alternative or adjunct to direct anastomosis.
    • This technique demonstrates fewer early and midterm complications compared to traditional methods.
    • It successfully avoids the use of an extracardiac conduit, simplifying surgical outcomes.