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Related Experiment Videos

Left ventricular reconditioning and anatomical correction for systemic right ventricular dysfunction.

Nancy C. Poirier1, Roger B.b. Mee

  • 1Center for Pediatric and Congenital Heart Disease, Cleveland Clinic Foundation, Cleveland, OH.

Seminars in Thoracic and Cardiovascular Surgery. Pediatric Cardiac Surgery Annual
|August 4, 2001
PubMed
Summary

Anatomical correction of the morphologically left ventricle (mLV) shows promise for treating right ventricle failure in transposition of the great arteries (TGA) and congenitally corrected TGA (cc-TGA). This surgical approach yields good results in younger patients, improving ventricular function.

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Area of Science:

  • Cardiology
  • Pediatric Cardiac Surgery
  • Congenital Heart Disease

Background:

  • Morphologically right ventricle (mRV) failure is a significant complication in patients with transposition of the great arteries (TGA) and congenitally corrected TGA (cc-TGA) after initial surgical management.
  • Conventional treatments for progressive mRV failure, such as tricuspid valve replacement and cardiac transplantation, have shown limited success.

Purpose of the Study:

  • To evaluate the efficacy of anatomical correction, reintroducing the morphologically left ventricle (mLV) into systemic circulation, for managing mRV failure in TGA and cc-TGA patients.
  • To assess the outcomes of mLV retraining and anatomical correction, particularly in relation to patient age and prior surgical history.

Main Methods:

  • A total of 84 patients (39 TGA, 45 cc-TGA) underwent anatomical correction at two institutions between 1981 and 1999.

Related Experiment Videos

  • Pulmonary artery banding was used to retrain the mLV for systemic pressure generation in 43 patients.
  • Outcomes were assessed through overall mortality, transplantation rates, and follow-up echocardiographic evaluations of ventricular function.

    • Main Results:

    • Overall mortality was 15.4%, with all operative deaths occurring in TGA patients with prior atrial switch operations.
    • Four patients (5%) required transplantation or were awaiting it.
    • Echocardiography in 46 survivors showed normal mRV function in 89% and normal mLV function in 91%.

    Conclusions:

    • Anatomical correction and mLV retraining demonstrate favorable outcomes, particularly in prepubescent patients with TGA and cc-TGA.
    • Older patients exhibit less predictable responses and higher early and late mortality.
    • This surgical strategy offers a viable alternative for managing complex congenital heart disease with mRV failure.