211278 Biventricular repair for endocardial cushion defects with double outlet right ventricle

/Li Fuli(李富驪，Dept Cardiovasc Surg，Liuzhou Peop Hosp，Liuzhou 545006)…∥Chin J Thorac Cardiovasc Surg.-2011，27(4).-197～199

ObjectiveDouble-outlet right ventricle，which often associated with total anomalous pulmonary venous connection and complete endocardial cushion defects，has been considered a risk factor for biventricular repair procedure.To reviewed cases treated by biventricular repair for endocardial cushion defects with double outlet right ventricle.MethodsFrom July to November of 2009，6 patients(3 males and 3 females)aged from 7 to 24(16.17 ±5.98)years and with endocardial cushion defects and double outlet right ventricle underwent operation of biventricular repair The duration of follow-up ranged from 10 days to 2 years(median，16 months).Endocardial cushion defects were repaired with a 2-patch technique.The artificial vascular patch was implanted to connect the ventricular septal defects and the aorta for draining the blood stream from the left ventricle to the aorta.The other patch was used to repair the ostium primum atrial septal defects.Right ventricular outflow tract obstructions was released and reconstructed by transplanting a bovine pericardium patch.If the size of pulmonary valve annulus was far more below the normal，a transannular pericardial patch was used.Rastelli procedure with a valved conduit between the right ventricle and the pulmonary artery would be performed if the obstruction in the right ventricular outfolw tract was severe.ResultsOne death occurred 2 days after the operation，resulting in a mortality rate of 16.6%.The case，a boy of 7 years old，had a mirror-image dextrocardia，complete endocardial cushion defect(C type)，anomalous pulmonary venous drainage and single atrium.In this case，the operation lasted for 8 hours，acute renal failure happened next day to the operation，the effect of CRRT was unsatisfied，and eventually cardiac arrest occurred as a result of hyperkalemia.The remaining cases survived.Follow-up examinations showed that the systolic pressure gradients across the pulmonary valves decreased，with a range of 14 to 40 mm Hg，(23.9 ±11.03)mm Hg.Mild mitral and tricuspid regurgiration were identified in 4 cases and moderate mitral regurgitation was identified in one case.The cardiac function in all patients was classified as NYHA classⅠ/Ⅱ，ConclusionEndocardial cushion defects with double outlet right ventricle can be corrected by means of biventricular repair procedure.The procedure was associated with a low mortality，The interim life quality of patients could be improved.The longterm outcomes should be further studied.4 refs.