scholarly journals Right ventricular outflow tract stenting in double outlet right ventricle with critical pulmonary stenosis and hypoplastic pulmonary arteries

2016 ◽  
Vol 3 ◽  
pp. 267-270
Author(s):  
Ewelina Kwaśniak ◽  
Ireneusz Haponiuk ◽  
Maciej Chojnicki ◽  
Radosław Jaworski ◽  
Aneta Szofer-Sendrowska ◽  
...  
Keyword(s):  
Right Ventricle ◽  
Right Ventricular ◽  
Pulmonary Stenosis ◽  
Pulmonary Arteries ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Double Outlet Right Ventricle ◽  
Outflow Tract ◽  
Critical Pulmonary Stenosis

scholarly journals Individualized Surgical Reconstruction of the Right Ventricle Outflow Tract in Double Outlet Right Ventricle With Mirror Image-Dextrocardia

2021 ◽  
Vol 9 ◽  
Author(s):  
Wangping Chen ◽  
Chukwuemeka Daniel Iroegbu ◽  
Xia Xie ◽  
Wenwu Zhou ◽  
Ming Wu ◽  
...  
Keyword(s):  
Right Ventricle ◽  
Right Ventricular ◽  
Pulmonary Stenosis ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Double Outlet Right Ventricle ◽  
Mirror Image ◽  
Outflow Tract ◽  
Surgical Reconstruction ◽  
The Right

Introduction: The purpose of this study was to report our experience in the surgical reconstruction of the right ventricular outflow tract in double outlet right ventricle with a major coronary artery crossing the right ventricular outflow tract in the presence of mirror image-dextrocardia.Methods: From January 2005 to December 2019, 19 double outlet right ventricle patients (median age 4 years) with mirror image-dextrocardia and a major coronary artery crossing the right ventricular outflow tract received surgical repair. An autologous pericardial patch was used to enlarge the right ventricular outflow tract in four patients without pulmonary stenosis and three patients with mild pulmonary stenosis. A valved bovine jugular venous conduit was added to a hypoplastic native pathway in nine patients, among which six patients with moderate pulmonary stenosis received small-sized bovine jugular venous conduit implantation (diameter ≤ 16 mm). In comparison, a large-sized bovine jugular venous conduit (diameter >16 mm) was adopted in a total of three patients with severe pulmonary stenosis. Finally, three patients with preoperative pulmonary hypertension (mean pulmonary artery pressure ≥40 mmHg) did not undergo further intervention of right ventricular outflow tract due to the adequate outflow tract blood flow.Results: There was no hospital mortality. One patient with sub-pulmonary ventricular septal defect and concomitant severe pulmonary hypertension died from respiratory failure 11 months after the operation. Kaplan-Meier survival was 94% at 5, 10 years. Within a mean echocardiographic follow-up of 6.9 ± 3.6 years, a total of two patients received reintervention due to valvular stenosis of the bovine jugular venous conduit (pressure gradient > 50 mmHg at 4 and 9 years) after surgical operation. Actuarial freedom from reoperation was 90 and 72% at 5 and 10 years, respectively. During the last echocardiographic follow-up phase, all the survivors were in NYHA class I.Conclusions: Double outlet right ventricle with mirror image-dextrocardia is a rare and complicated congenital cardiac malformation. Surgical reconstruction of the right ventricular outflow tract should be individualized based on the degree of pulmonary stenosis and the specific anatomical features of each patient. Reconstructing the pulmonary artery using the various sizes of valved bovine jugular venous conduit is a safe and effective surgical method.

Right ventricular outflow tract obstruction (RVOTO)

2011 ◽  
Keyword(s):  
Pulmonary Artery ◽  
Right Ventricle ◽  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Pulmonary Stenosis ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Outflow Tract ◽  
Pulmonary Artery Stenosis ◽  
Pulmonary Valvar Stenosis

Introduction 82Pulmonary valvar stenosis 82Supravalvar pulmonary stenosis 84Pulmonary artery stenosis 84Double-chambered right ventricle 84RVOTO can be due to abnormalities at the following levels: • Mid RV.• Infundibulum (as in tetralogy of Fallot).• PV.• Supravalvular region.• Branch ± peripheral PAs....

scholarly journals Evolving management for critical pulmonary stenosis in neonates and young infants

2000 ◽  
Vol 10 (3) ◽  
pp. 186-192 ◽  
Author(s):  
Yiu-fai Cheung ◽  
Maurice P. Leung ◽  
Jan W. T. Lee ◽  
Adolphus K. T. Chau ◽  
Tak-cheung Yung
Keyword(s):  
Right Ventricular ◽  
Pulmonary Stenosis ◽  
Balloon Dilation ◽  
Systolic Pressure ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Outflow Tract ◽  
Young Infants ◽  
The Right ◽  
Critical Pulmonary Stenosis

AbstractOver the years, management of critical pulmonary stenosis in young infants has evolved from surgical reconstruction of the right ventricular outflow tract and closed pulmonary valvotomy to transcatheter balloon valvoplasty. Our study aimed at evaluating how the changing policy for management had affected the immediate and long term outcomes of babies with this cardiac lesion. Interventions were made in 34 infants at a median age of 8.5 days (2–90 days). Reconstruction of the right ventricular outflow tract reconstruction was performed in 10 patients, closed pulmonary valvotomy in 13, and balloon valvoplasty in 11. Initial procedure-related mortality was 50%, 15% and 0% respectively. Multivariate analysis revealed transannular patching of the right ventricular outflow tract, and male sex, to be significant factors for death. For the 27 survivors, the ratio of right ventricular to systemic systolic pressure decreased from 1.6 ± 0.3 to 0.3 ± 0.2 after reconstruction of the outflow tract, 1.8 ± 0.5 to 0.8 ± 0.4 after closed valvotomy, and 1.8 ± 0.6 to 0.9 ± 0.3 after balloon valvoplasty. The decrease was significantly greater after patch reconstruction (p=0.025) that required no further reinterventions. The overall rate of reintervention for the survivors was 37% (10/27). The freedom from reintervention after closed valvotomy was 82%, 64% and 51% at 1, 5 and 10 years respectively. The figure remained at 78% at both 1 and 5 years (p=0.66) after balloon valvoplasty. The higher reintervention rate for closed valvotomy corresponded to the significantly greater residual gradient across the pulmonary valve noted on follow-up (p=0.01). Reinterventions included balloon dilation (n=6), reconstruction of the outflow tract (n=4), and 1 each of ligation of an arterial duct and systemic-pulmonary arterial shunting. The risk factor for reintervention was a hypoplastic right ventricle. In conclusion, transcatheter balloon valvoplasty appears to be the optimum initial approach in view of its low mortality, efficacy at relieving the obstruction, and low rate of reintervention.

scholarly journals Right ventricular outflow tract stenting during neonatal and infancy periods: A multi-center, retrospective study

2020 ◽  
Vol 28 (3) ◽  
pp. 442-449
Author(s):  
İbrahim Cansaran İbrahim Cansaran Tanıdır
Keyword(s):  
Right Ventricular ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Double Outlet Right Ventricle ◽  
Outflow Tract ◽  
Complex Congenital Heart Disease ◽  
Total Correction ◽  
Study Results ◽  
Correction Surgery

Background: The aim of this study was to evaluate the outcomes of right ventricular outflow tract stenting for palliation during the newborn and infancy periods. Methods: Between January 2013 and January 2018, a total of 38 patients (20 males, 18 females; median age 51 days; range, 3 days to 9 months) who underwent transcatheter right ventricular outflow tract stenting in three centers were retrospectively analyzed. Demographic characteristics, cardiac pathologies, angiographic procedural, and clinical follow-up data of the patients were recorded. Results: The diagnoses of the cases were tetralogy of Fallot (n=27), double outlet right ventricle (n=8), complex congenital heart disease (n=2), and Ebstein’s anomaly (n=1). The median weight at the time of stent implantation was 3.5 (range, 2 to 10) kg. Five cases had genetic abnormalities. The median pre-procedural oxygen saturation was 63% (range, 44 to 80%), and the median procedural time was 60 (range, 25 to 120) min. Acute procedural success ratio was 87%. Reintervention was needed in seven of patients due to stent narrowing during follow-up. During follow-up period, seven cases died. Total correction surgery was performed in 26 patients without any mortality. While a transannular patch was used in 22 patients, valve protective surgery was implemented in two patients, and the bidirectional Glenn procedure was performed in two patients. Conclusion: Based on our study results, right ventricular outflow tract stenting is a form of palliation which should be considered particularly in cases in whom total correction surgery is unable to be performed due to morbidity.

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