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Double outlet right ventricle: opinions regarding management
Frank Cetta1, Umar S Boston, Joseph A Dearani
1Division of Pediatric Cardiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. cetta.frank@mayo.edu
Current Treatment Options in Cardiovascular Medicine
|September 6, 2005
Summary
Surgical repair for double outlet right ventricle (DORV) depends on defect anatomy. Management options range from intraventricular tunnels to staged palliative approaches like the Fontan procedure, each with specific long-term outcomes.
Area of Science:
- Congenital Heart Surgery
- Pediatric Cardiology
- Cardiovascular Surgery
Background:
- Double outlet right ventricle (DORV) presents diverse anatomical challenges.
- Surgical management of DORV requires tailored strategies based on ventricular septal defect (VSD) and great artery relationships.
Purpose of the Study:
- To review current management options for double outlet right ventricle (DORV).
- To outline surgical repair strategies based on specific DORV anatomies.
- To discuss the outcomes and potential long-term complications associated with different DORV surgical approaches.
Main Methods:
- Review of surgical repair techniques for DORV.
- Classification of DORV based on VSD location and associated obstructions.
- Analysis of outcomes and reoperation risks for various surgical strategies, including intraventricular tunnels, conduit placement, arterial switch operations, and staged palliative approaches (Fontan procedure).
Main Results:
- Intraventricular tunnels are used for subaortic or doubly committed VSDs without outflow tract obstruction.
- Right ventricular outflow tract obstruction necessitates augmentation or conduit placement.
- Arterial switch operations are indicated for Taussig-Bing anomaly (subpulmonary VSD), with good initial results but risk of neoaortic regurgitation.
- Staged palliative approaches (Fontan procedure) are used for complex cases, improving survival but carrying risks of arrhythmia and protein-losing enteropathy.
- Conduit placement requires future replacement, and complex repairs have higher reoperation rates.
Conclusions:
- Surgical outcomes for DORV are highly dependent on the chosen repair strategy and patient's specific anatomy.
- While advancements have improved survival, long-term surveillance is crucial for managing potential complications like reoperations, valve issues, arrhythmias, and protein-losing enteropathy.