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Biventricular repair for right atrial isomerism.
Masahiro Koh1, Toshikatsu Yagihara, Hideki Uemura
1Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan.
The Annals of Thoracic Surgery
|April 25, 2006
Summary
Biventricular repair offers good long-term outcomes for right atrial isomerism patients, proving a viable alternative to the Fontan procedure in select cases.
Area of Science:
- Congenital heart disease
- Pediatric cardiology
- Cardiac surgery
Background:
- Right atrial isomerism presents complex anatomical challenges for biventricular repair.
- The Fontan procedure is often unsuitable for these patients.
Purpose of the Study:
- To evaluate the outcomes of biventricular repair in patients with right atrial isomerism.
- To compare these outcomes with the Fontan procedure.
Main Methods:
- Ten patients with right atrial isomerism underwent biventricular repair, with varied atrioventricular valve types and associated anomalies.
- Surgical techniques included intra-atrial baffle rerouting, ventricular septation, and major aortopulmonary collateral artery unifocalization.
- Outcomes were compared to 97 patients who underwent the Fontan procedure.
Main Results:
- Biventricular repair had 3 early and 1 late death, with 6 survivors in NYHA functional class I or II.
- No significant differences were observed in survival, arrhythmia, reoperation rates, or exercise tolerance compared to the Fontan procedure.
- Two patients required reoperation due to infection or prosthetic valve failure.
Conclusions:
- Biventricular repair demonstrates favorable long-term results in patients with right atrial isomerism.
- It serves as an acceptable alternative to the Fontan procedure in carefully selected individuals.