Day R, Laks H, Milgalter E, Billingsley A, Rosengart R, George B
Division of Pediatric Cardiology, University of California, Los Angeles 90024.
Ann Thorac Surg. 1990 Jun;49(6):1003-5. doi: 10.1016/0003-4975(90)90890-i.
The presence of left ventricular hypoplasia in double-outlet right ventricle may increase the risk of biventricular repair and Fontan procedures. The hypoplastic left ventricle of an 11-year-old girl with complex double-outlet right ventricle was successfully incorporated in a modified biventricular repair by Dacron patch closure of the ventricular septal defect, diversion of venous return of the inferior vena cava to the mitral valve with an intraatrial baffle, insertion of a left ventricular apex to pulmonary artery valved aortic homograft, and diversion of residual systemic venous return directly to the lungs with a bidirectional superior vena cava to pulmonary artery shunt. Postoperatively, the systemic venous atrial pressure was 6 mm Hg and the pulmonary artery pressure was 14 mm Hg. This method is proposed as a partial biventricular repair hemodynamically superior to the Fontan procedure, although aortic homograft revision may be required in the future.
右心室双出口合并左心室发育不全可能会增加双心室修复和Fontan手术的风险。一名患有复杂右心室双出口的11岁女孩的发育不全左心室，通过以下方式成功纳入改良双心室修复：用涤纶补片闭合室间隔缺损、通过心房内挡板将下腔静脉的静脉回流改道至二尖瓣、将带瓣主动脉同种异体移植物的左心室心尖插入肺动脉、以及通过双向腔静脉-肺动脉分流将残余的体循环静脉回流直接改道至肺部。术后，体循环静脉心房压为6mmHg，肺动脉压为14mmHg。尽管未来可能需要对主动脉同种异体移植物进行翻修，但该方法被认为是一种在血流动力学上优于Fontan手术的部分双心室修复方法。
