Surgical Management of Left Ventricular Outflow Tract Obstruction after Biventricular Repair of Double Outlet Right Ventricle

• Published in: Journal of Korean medical science Vol. 25; no. 3; pp. 374 - 379
• Main Authors: Kim, Chang Young, Kim, Woong-Han, Kwak, Jae Gun, Jang, Woo-Sung, Lee, Chang-Ha, Kim, Dong Jin, Lim, Cheong, Chang, Woo Ik
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Academy of Medical Sciences 01.03.2010; 대한의학회
• Subjects: Blood Pressure - physiology; Child, Preschool; Double Outlet Right Ventricle - pathology; Double Outlet Right Ventricle - surgery; Female; Heart Defects, Congenital - pathology; Heart Defects, Congenital - surgery; Humans; Infant; Male; Original; Postoperative Complications - surgery; Reoperation; Retrospective Studies; Treatment Outcome; Ventricular Outflow Obstruction - etiology; Ventricular Outflow Obstruction - surgery; 의학일반; Aortic Stenosis, Subvalvular; DORV
• ISSN: 1011-8934; 1598-6357; 1598-6357
• DOI: 10.3346/jkms.2010.25.3.374

Regardless of the preoperative morphology and the type of operation, left ventricular outflow tract obstruction (LVOTO) after biventricular repair of double outlet right ventricle (DORV) may develop. This report presents our 10-yr experience with surgical management of LVOTO after biventricular repair of DORV. Between 1996 and 2006, 15 patients underwent reoperation for subaortic stenosis after biventricular repair of DORV. The mean age at biventricular repair was 23.3+/-18.3 months (1.1-64.2). Biventricular repairs included tunnel constructions from the left ventricle to the aorta in 14 cases and an arterial switch operation in one. The mean left ventricle-to-aorta peak pressure gradient was 54.0+/-37.7 mmHg (15-140) after a mean follow-up of 9.5+/-6.3 yr. We performed extended septoplasty in nine patients and fibromuscular resection in six. There were no early or late mortality. There was one heart block and one aortic valve injury after an extended septoplasty, and two and one after a fibromuscular resection. No patient required reoperation for recurrent subaortic stenosis. The mean pressure gradient was 11.2+/-11.4 mmHg (0-34) after a mean follow-up of 5.6+/-2.7 yr. Extended septoplasty is a safe and effective method for the treatment of subaortic stenosis, especially in cases with a long-tunnel shaped LVOTO.