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Ventricular septation for double inlet ventricle: Avoiding conduction injury.
Ajami Gikandi1, Jocelyn Davee1, Edward T O'Leary2
1Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Mass.
The Journal of Thoracic and Cardiovascular Surgery
|September 28, 2024
Summary
Intraoperative conduction mapping during ventricular septation can improve accuracy in predicting heart block. This procedure offers a safe alternative to the Fontan procedure with good early outcomes for select patients.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Disease
- Electrophysiology
Background:
- Ventricular septation is a complex procedure for congenital heart disease.
- Complete heart block remains a significant risk despite accurate conduction location prediction.
Purpose of the Study:
- To evaluate the utility of intraoperative conduction mapping during ventricular septation.
- To assess the safety and early outcomes of ventricular septation as an alternative to the Fontan procedure.
Main Methods:
- Conduction mapping was performed on the beating heart to identify the His bundle in patients undergoing ventricular septation.
- Mapped His bundle locations were compared with pre-operative predictions.
- Outcomes including heart block, reoperations, and hemodynamics were analyzed.
Main Results:
- Conduction mapping showed concordance with predicted locations in most patients.
- Complete heart block occurred in 4 patients despite mapping.
- No perioperative mortality or need for single-ventricle palliation was observed.
- Patients demonstrated acceptable hemodynamics and ventricular function at follow-up.
Conclusions:
- Ventricular septation is a safe alternative to the Fontan procedure for select patients with acceptable early outcomes.
- Intraoperative conduction mapping can enhance the precision of predicting conduction location during ventricular septation.
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