[Reconstruction of underdeveloped right ventricle and tricuspid hypoplasia (author's transl)]

Total correction of underdeveloped right ventricle related to tricuspid hypoplasia has been performed in 6 patients at the department of thoracic and cardiovascular surgery University Göttingen. In 5 patients reconstruction of a four-chamber-four-valved heart could be accomplished. 1 patient with a poor result after Fontan's operation, performed one year previously, showed a significant growth in size of the hypoplastic right ventricle in the postoperative angiogram, but died 14 hours after reoperation. Prior to corrective surgery, 4 patients required 1 or 2 palliative procedures: 3 Glenn- and 2 Blalock-Taussig operations and a pulmonary valvulotomy in 1 patient. A Hancock-valved conduit was inserted between the right atrium and the hypoplastic right ventricle as an inlet of this chamber after closure of the ASD and VSD in 4 patients. The conduits are bypassing the hypoplastic tricuspid valve orifices closed during corrective surgery. In the remainder 2 patients with moderate tricuspid and right ventricle hypoplasia, closure of the ASD was performed only. Anomalous muscle bundles and fibrous tissue inside the right ventricular cavity were resected surgically, safely. 4 to 12 months after corrective surgery the 5 survivors were investigated by cardiac catheterization. In the 3 patients operated with a valved conduit there was a moderate growth in size of the hypoplastic right ventricle, the right atrial pressure was elevated and ranged from p = 14 to 16 mm Hg. There was a slight right atrial-right ventricular gradient of 4 mm Hg across the valved conduit. The 2 patients with closure of the ASD and VSD only had a nearly normal-sized right ventricle and a right atrial pressure of p = 10 mm Hg or less at the postoperative right ventricle and a right atrial pressure of p = 10 mm Hg or less at the postoperative investigation. All of them were acyanotic and had an improved or normal exercise tolerance. We concluded that reconstruction of an underdeveloped right ventricle in well-selected cases will yield more physiological benefits than do current surgical procedures, in which a conduit is interposed between the right atrium and the main pulmonary artery.