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Morphosurgical correlation of outcomes in complete double outlet right ventricle

Department of Pediatric Cardiac Surgery, Apollo Children's Heart Hospital, Jubilee Hills, Hyderabad, India – 500034

*Corresponding author. Tel.: +91 40 23600852, 23607777-Ext: 3048; fax: +91 40 23608050.

E-mail address: konasmurthy{at}gmail.com (K.S. Murthy).

Even though surgical experience with wide spectrum of double outlet right ventricle (DORV) is available, the experience with extreme form of complete DORV where both great arteries completely arise from the right ventricle is limited. We present our experience with this unique subset where the systemic outflow is far removed from the interventricular foramen and hence, the systemic ventricle. In this situation, biventricular repair can be technically demanding and challenging. Between June 2002 and February 2006, 12 patients underwent biventricular repair of this subset. The VSD was subaortic in all; eight patients had infundibular and valvar obstruction. Aorta was anterior and to the right, with the pulmonary artery far posterior and to the left. The interventricular foramen was patched with a long Gore-Tex patch to route the LV flow to the aorta. Eight patients had infundibular resection and right ventricular outflow tract (RVOT) enlargement with an autologous monocusp pericardial patch. No patient required a valved conduit. There was no operative mortality. In one patient, there was a small residual VSD that was not of haemodynamic significance. There was no RVOT and left ventricular outflow tract obstruction and no RV inflow obstruction. The early and mid-term results are good.

Key Words: Double outlet right ventricle; Biventricular repair; Congenital; Morphogenesis