Right and left ventricular volume characteristics after external conduit repair (Rastelli procedure) for cyanotic congenital heart disease.

We studied right and left ventricular (RV and LV) volume characteristics in 18 patients who had undergone an external conduit repair (Rastelli procedure) at 3-17 years of age (mean 7.5 years). Cardiac output, measured by means of a thermodilution method, was 3.8 +/- 0.8 1/min/m2 (mean +/- SD). Peak RV pressure was 104 +/- 28 mmHg in six patients who had been operated on 6 years or more before this study, significantly higher than in patients with a shorter follow-up period (72 +/- 19 mmHg for 1-5 years follow-up in six patients and 54 +/- 10 mmHg at 1 month after operation in six patients). RV end-diastolic volume (EDV) was 113% +/- 40% of normal, and RV ejection fraction (EF) was 0.52 +/- 0.10, lower than normal. RVEDV was inversely correlated with peak RV pressure (r = -0.78). This parameter was 0.42 +/- 0.06 in the six patients with the longest follow-up period, lower than in the other two groups (0.52 +/- 0.08 in 1-5 years follow-up, 0.60 +/- 0.03 at 1 month after surgery). LVEF was 151% +/- 38% of normal. LVEF was lower than normal in 6 of 12 patients who underwent surgery at the age of 6 years or more and in none of the six younger patients. The data indicate that in these patients, RVEF decreases with the increase of peak RV pressure and the increase in time since operation, especially 6 years or more after surgery. LV pump function is also depressed, possibly partly because of longstanding pre-operative hypoxemia.