Reoperation for Left Ventricular Outflow Tract Obstruction After Repair of Atrioventricular Septal

Left ventricular outflow tract obstruction (LVOTO) is an important source of morbidity and mortality after repair of atrioventricular septal defect (AVSD). The intrinsic anatomy of the left ventricular outflow tract in AVSD is complex and predisposes to the development of LVOTO. LVOTO after repair of AVSD usually involves multiple levels and sources of obstruction, and surgical intervention must address each component of the obstruction. This includes fibromuscular obstruction, septal hypertrophy, and valve related sources of obstruction. Special attention is also directed to the anterolateral muscle bundle of the left ventricle, a well defined but under recognized feature of the left ventricular outflow tract in AVSD. It is present in all patients with AVSD, and resection of a hypertrophic anterolateral muscle bundle of the left ventricle should be incorporated in all operations for LVOTO after repair of AVSD. LVOTO after repair of AVSD has several unique features that must be taken into consideration to maximize outcome after surgical intervention. These include anatomic factors, technical aspects of surgical intervention, and proper selection of the operation used for relief of LVOTO.     

Evaluation of Gore-Tex Graft Material in the Repair of Right Ventricular Outflow Tract Defect

Following right ventriculotomy, Gore-Tex PTFE vascular grafts were placed in eight neutered male, 6- to 8-week-old, 8- to 12-kg pigs. Ten to 14 months after surgery each pig was evaluated by right heart catheterization. The swine were sacrificed and the hearts were evaluated grossly and microscopically. Comparison of the mean derived cardiovascular hemodynamic parameters in this group with published data on swine and humans indicated normal cardiovascular physiology. Since there was no gradient across the patched areas, it appears that the patches had no adverse effects on the cardiovascular system of growing pigs over an approximately 1-year time period. In addition, the Gore-Tex appeared to be satisfactory for the repair of right ventricular outflow enlargement. Its relative ease of handling, configuration, and lack of aneurysm formation were advantages over other available materials. However, focal calcification and chronic inflammatory reaction did indicate the possibility of long-term prosthetic failure.     

Transesophageal Echocardiographic Predictor of Significant Right Ventricular Outflow Tract Obstruction After Tetralogy of Fallot Repair

Graphical abstract shows perioperative management of patients with tetralogy of Fallot (ToF). Patients with pulmonary valve (PV) z-score ≥−3.2 should receive ToF repair with PV preservation, while those with PV z-score <−3.2—ToF repair with transannular patch. All patients should be assessed by intraoperative transesophageal echocardiography (ITEE) with right ventricular outflow tract (RVOT) z-score. Patients with RVOT z-score <−3.2 should underwent additional subpulmonary muscular resection, while those with RVOT z-score ≥−3.2 should complete the operation.

1. Download : Download high-res image (104KB)
2. Download : Download full-size image

     

Isolated Accessory Tricuspid Valve Causing Right Ventricular Outflow Tract Obstruction

Abstract Accessory tricuspid valve (TV) tissue is a rare congenital cardiac anomaly with varying clinical and hemodynamic features. We report a rare case of accessory TV tissue causing severe right ventricular outflow tract obstruction (RVOT) in a patient without associated cardiac anomaly. Surgical resection of the isolated accessory TV tissue resulted in complete relief of the RVOT without compromising TV function . (J Card Surg 2010;25:410‐411)     

改良主、肺动脉根部置换术治疗伴左室流出道梗阻的大动脉错位

目的 探讨一种新的主、肺动脉根部置换手术治疗合并室间隔缺损(VSD)、左室流出道梗阻(LVOTO)的大动脉错位(TGA).方法 4例伴LVOTO、VSD的TGA患者及1例伴LVOTO、VSD的右心室双流出口患者,被采用改良的Nikaidoh技术将主动脉和肺动脉根部完整互换移植、冠状动脉移植以及双心室流出道重建;其中2例房室异常连接患者被同期施行Senning手术.结果 所有患者手术均获成功,术后恢复良好.术后平均随访5.40个月,生长发育好.超声心动图检查提示心室功能良好,主动脉瓣无反流;2例患者肺动脉瓣有少量反流.结论 保留半月瓣的主、肺动脉根部置换术治疗伴LVOTO的复杂型TGA患者,不仅可获得解剖根治,同时解决了右心室流出道的非生长性问题,改进的冠状动脉再植技术扩大了Nikaidoh手术的适应范围,并获得很好的近期疗效.但其远期疗效仍需更大组的手术例数及更长期的随访来验证.     

Repair of Postinfarction Ventricular Septal Defect

Recently I successfully repaired a necrotic, acute septal defect by modifying the standard intracavitary repair of postinfarction aneurysm. The technique was modified after a patient who had undergone standard intracavitary repair developed a systolic murmur and had to be returned to surgery, where I found that the continuous suture had become detached at the posterlor extent of the repair. The pericardial baffle was reattached using interrupted sutures with felt pledgets. As a result of this experience, we have modified our standard intracavitary repair for postinfarction aneurysm to account for the area of necrotic myocardium often associated with acute septal defects.