Application of One and A Half Ventricle Repair for Acute Right Ventricular Dysfunction after Biventricular Repair_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

JI Zhixian , XING Quansheng , DUAN Shuhua , REN Yueyi , HOU Kefeng.

Department of Heart Center，Qingdao Women and Children Hospital，Affiliated Women and Children Hospital of Qingdao University Medical College，Qingdao 266034，Shandong，P. R. China;

Corresponding author：

Keywords：

Congenital heart disease; One and a half ventricle repair; Biventricular repair; Right ventricular dysfunction

DOI：

10.7507/1007-4848.20130124

Video：

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Objective To investigate clinical outcomes of one and a half ventricle repair for acute right ventricular dysfunction after biventricular repair. Methods Clinical data of 5 pediatric patients with congenital heart diseases who underwent emergency bidirectional Glenn shunt without cardiopulmonary bypass for acute right ventricular dysfunction after biventricular repair，converting the operation into one and a half ventricle repair，from February 2007 to June 2012 in Qingdao Women and Children Hospital were retrospectively analyzed. There were 4 male patients and 1 female patient with their age of 7-18 months and body weight of 6-13 kg. Preoperative diagnosis included pulmonary atresia with intact　ventricular septum （PA/IVS） in 1 patient，tricuspid stenosis （TS） with ventricular septal defect （VSD） and atrial septal　defect （ASD） in 2 patients，and tricuspid stenosis with tetralogy of Fallot （TOF） in 2 patients. Postoperative care focused on cardiopulmonary support and control of pulmonary artery pressure. Results Mean pulmonary artery pressure （mPAP） was 12-18 mm Hg at 72 hours after emergency bidirectional Glenn shunt. Mechanical ventilation time was 3-182 hours and ICU stay was 2-13 days. Postoperatively 1 patient died of pulmonary hypertension crisis. The other 4 patients were discharged　with their transcutaneous oxygen saturation in the resting state of 93%-99%，which was improved in different degrees compared with preoperative value. These 4 patients were followed up from 6 months to 4 years. Three patients were in NYHA classⅠand 1 patient was in NYHA class Ⅱ during follow-up. Echocardiography showed smooth vena cava to pulmonary artery anastomosis without thrombosis formation. Conclusion One and a half ventricle repair can be used as an adjunct surgical strategy for acute right ventricular dysfunction after biventricular repair.

Citation： JI Zhixian,XING Quansheng,DUAN Shuhua,REN Yueyi,HOU Kefeng.. Application of One and A Half Ventricle Repair for Acute Right Ventricular Dysfunction after Biventricular Repair. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2013, 20(4): 392-395. doi: 10.7507/1007-4848.20130124 Copy

1.	Stellin G， Vida VL， Milanesi O， et al. Surgical treatment of complex　cardiac anomalies： the 'one and one half ventricle repair'. Eur J　Cardiothorac Surg， 2002， 22 （6）： 1043-1049.
2.	Maluf MA， Carvalho AC， Carvalho WB. One and a half ventricular repair as an alternative for hypoplastic right ventricle . Rev Bras Cir Cardiovasc， 2010 ， 25 （4）：466-473.
3.	Lee YO， Kim YJ， Lee JR， et al. Long-term results of one-and-a-half　ventricle repair in complex cardiac anomalies. Eur J Cardiothorac Surg， 2011， 39 （5）： 711-715.
4.	程前进，马黎明，褚衍林，等. Ebstein畸形的外科治疗. 中国医师进修杂志， 2012， 35 （32）：16-18.
5.	Numata S， Uemura H， Yagihara T， et al. Long-term functional　results of the one and one half ventricular repair for the spectrum of patients with pulmonary atresia/stenosis with intact ventricular　septum. Eur J Cardiothorac Surg， 2003， 24 （4）： 516-520.
6.	Chowdhury UK， Airan B， Sharma R， et al. One and a half ventricle repair with pulsatile bidirectional Glenn： results and guidelines for patient selection. Ann Thorac Surg， 2001， 71 （6）： 1995-2002.
7.	Liu JF， Qiu LS， Zhu ZQ， et al. Cone reconstruction of the tricuspid valve in Ebstein anomaly with or without one and a half ventricle repair. J Thorac Cardiovasc Surg， 2011， 141 （5）： 1178-1183.
8.	丁芳宝，梅举，邹良建，等. 非体外循环下有搏动性双向Glenn手术治疗复杂先天性心脏病. 中国胸心血管外科临床杂志， 2005， 12 （1）：46-47.
9.	林国强，罗万俊，黄日茂，等. 双向Glenn手术治疗成人先天性三尖瓣狭窄合并肺动脉瓣狭窄卵圆孔未闭1例. 中国胸心血管外科临床杂志， 2008， 15 （4）：318.
10.	Mavroudis C， Backer CL， Kohr LM， et al. Bidirectional glenn shunt in association with congenital heart repairs：the one and a half ventricular repair. Ann Thorac Surg， 1999， 68 （3）： 976-982.
11.	Sharma V， Burkhart HM， Cetta F， et al. Fontan conversion to one and one half ventricle repair. Ann Thorac Surg， 2012， 94 （4）： 1269-1274.
12.	Stocker CF， Shekerdemian LS， Horton SB， et al. The influence of bypass temperature on the systemic inflammatory response and organ injury after pediatric open surgery： a randomized trial. J Thorac　Cardiovasc Surg， 2011， 142 （1）： 174-180.
13.	Sitniakowsky LS， Later AF， van de Watering LM， et al. The effect　of RBC transfusions on cytokine gene expression after cardiac surgery　in patients developing post-operative multiple organ failure. Transfus Med， 2011， 21 （4）： 236-246.
14.	Villagrá F， Gómez R， Ignacio Herraiz J， et al. The bidirectional cavopulmonary （Glenn） shunt without cardiopulmonary bypass： a safe and advisable technique. Rev Esp Cardiol， 2000， 53 （10）： 1406-1409.
15.	Bhan A. Off-pump bi-directional Glenn shunt： How I do it ? Ann Pediatr Cardiol， 2008， 1 （2）： 131-134.
16.	邢泉生，纪志娴，荣佑宝，等. 非体外循环双向Glenn手术治疗小儿复杂先天性心脏病. 中国胸心血管外科临床杂志， 2010， 17 （3）：252-253.
17.	Lapar DJ， Mery CM， Peeler BB， et al. Short and long-term outcomes　for bidirectional glenn procedure performed with and without cardiopulmonary bypass. Ann Thorac Surg， 2012， 94 （1）： 164-170.
18.	贝亚军，张载高，李寒，等. 右心旁路手术治疗复杂先天性心脏病. 中国体外循环杂志， 2008， 6 （4）：236-238.
19.	Jacobs ML， Pelletier GJ， Pourmoghadam KK， et al. Protocols associated with no mortality in 100 consecutive Fontan procedures. Eur J Cardiothorac Surg， 2008， 33 （4）： 626-632.
20.	Hanslik A， Thom K， Haumer M， et al. Incidence and diagnosis of thrombosis in children with short-term central venous lines of the upper　venous system. Pediatrics， 2008， 122 （6）： 1284-1291.
21.	闫军，罗新锦，许建屏，等. 一个半心室矫治术的临床应用. 中国循环杂志， 2001， 16 （2）：129-131.
22.	杨克明，郑帅，花中东，等. 一个半心室治疗的新领域—心脏位置异常的复杂矫正型大动脉转位矫治术. 中国胸心血管外科临床杂志， 2012， 19 （2）：193-196.
23.	Chung JW， Goo HW， Im YM， et al. One and a half ventricle repair　in adults： postoperative hemodynamic assessment using phase-contrast magnetic resonance imaging. Ann Thorac Surg， 2011， 92 （1）： 193-198.
24.	Uribe S， Bächler P， Valverde I， et al. Hemodynamic assessment in patients with one-and-a-half ventricle repair revealed by four-dimensional flow magnetic resonance imaging. Pediatr Cardiol， 2013， 34 （2）： 447-451.

1. 　Stellin G， Vida VL， Milanesi O， et al. Surgical treatment of complex　cardiac anomalies： the 'one and one half ventricle repair'. Eur J　Cardiothorac Surg， 2002， 22 （6）： 1043-1049.
2. 　Maluf MA， Carvalho AC， Carvalho WB. One and a half ventricular repair as an alternative for hypoplastic right ventricle . Rev Bras Cir Cardiovasc， 2010 ， 25 （4）：466-473.
3. 　Lee YO， Kim YJ， Lee JR， et al. Long-term results of one-and-a-half　ventricle repair in complex cardiac anomalies. Eur J Cardiothorac Surg， 2011， 39 （5）： 711-715.
4. 　程前进，马黎明，褚衍林，等. Ebstein畸形的外科治疗. 中国医师进修杂志， 2012， 35 （32）：16-18.
5. 　Numata S， Uemura H， Yagihara T， et al. Long-term functional　results of the one and one half ventricular repair for the spectrum of patients with pulmonary atresia/stenosis with intact ventricular　septum. Eur J Cardiothorac Surg， 2003， 24 （4）： 516-520.
6. 　Chowdhury UK， Airan B， Sharma R， et al. One and a half ventricle repair with pulsatile bidirectional Glenn： results and guidelines for patient selection. Ann Thorac Surg， 2001， 71 （6）： 1995-2002.
7. 　Liu JF， Qiu LS， Zhu ZQ， et al. Cone reconstruction of the tricuspid valve in Ebstein anomaly with or without one and a half ventricle repair. J Thorac Cardiovasc Surg， 2011， 141 （5）： 1178-1183.
8. 　丁芳宝，梅举，邹良建，等. 非体外循环下有搏动性双向Glenn手术治疗复杂先天性心脏病. 中国胸心血管外科临床杂志， 2005， 12 （1）：46-47.
9. 　林国强，罗万俊，黄日茂，等. 双向Glenn手术治疗成人先天性三尖瓣狭窄合并肺动脉瓣狭窄卵圆孔未闭1例. 中国胸心血管外科临床杂志， 2008， 15 （4）：318.
10. 　Mavroudis C， Backer CL， Kohr LM， et al. Bidirectional glenn shunt in association with congenital heart repairs：the one and a half ventricular repair. Ann Thorac Surg， 1999， 68 （3）： 976-982.
11. 　Sharma V， Burkhart HM， Cetta F， et al. Fontan conversion to one and one half ventricle repair. Ann Thorac Surg， 2012， 94 （4）： 1269-1274.
12. 　Stocker CF， Shekerdemian LS， Horton SB， et al. The influence of bypass temperature on the systemic inflammatory response and organ injury after pediatric open surgery： a randomized trial. J Thorac　Cardiovasc Surg， 2011， 142 （1）： 174-180.
13. 　Sitniakowsky LS， Later AF， van de Watering LM， et al. The effect　of RBC transfusions on cytokine gene expression after cardiac surgery　in patients developing post-operative multiple organ failure. Transfus Med， 2011， 21 （4）： 236-246.
14. 　Villagrá F， Gómez R， Ignacio Herraiz J， et al. The bidirectional cavopulmonary （Glenn） shunt without cardiopulmonary bypass： a safe and advisable technique. Rev Esp Cardiol， 2000， 53 （10）： 1406-1409.
15. 　Bhan A. Off-pump bi-directional Glenn shunt： How I do it ? Ann Pediatr Cardiol， 2008， 1 （2）： 131-134.
16. 　邢泉生，纪志娴，荣佑宝，等. 非体外循环双向Glenn手术治疗小儿复杂先天性心脏病. 中国胸心血管外科临床杂志， 2010， 17 （3）：252-253.
17. 　Lapar DJ， Mery CM， Peeler BB， et al. Short and long-term outcomes　for bidirectional glenn procedure performed with and without cardiopulmonary bypass. Ann Thorac Surg， 2012， 94 （1）： 164-170.
18. 　贝亚军，张载高，李寒，等. 右心旁路手术治疗复杂先天性心脏病. 中国体外循环杂志， 2008， 6 （4）：236-238.
19. 　Jacobs ML， Pelletier GJ， Pourmoghadam KK， et al. Protocols associated with no mortality in 100 consecutive Fontan procedures. Eur J Cardiothorac Surg， 2008， 33 （4）： 626-632.
20. 　Hanslik A， Thom K， Haumer M， et al. Incidence and diagnosis of thrombosis in children with short-term central venous lines of the upper　venous system. Pediatrics， 2008， 122 （6）： 1284-1291.
21. 　闫军，罗新锦，许建屏，等. 一个半心室矫治术的临床应用. 中国循环杂志， 2001， 16 （2）：129-131.
22. 　杨克明，郑帅，花中东，等. 一个半心室治疗的新领域—心脏位置异常的复杂矫正型大动脉转位矫治术. 中国胸心血管外科临床杂志， 2012， 19 （2）：193-196.
23. 　Chung JW， Goo HW， Im YM， et al. One and a half ventricle repair　in adults： postoperative hemodynamic assessment using phase-contrast magnetic resonance imaging. Ann Thorac Surg， 2011， 92 （1）： 193-198.
24. 　Uribe S， Bächler P， Valverde I， et al. Hemodynamic assessment in patients with one-and-a-half ventricle repair revealed by four-dimensional flow magnetic resonance imaging. Pediatr Cardiol， 2013， 34 （2）： 447-451.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Application of One and A Half Ventricle Repair for Acute Right Ventricular Dysfunction after Biventricular Repair

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