Morphological Observations following “Anatomical Correction” for Abnormal Ventriculo-arterial Connection

M. B. Rossi; S. Y. Ho; R. H. Anderson; K. Kanter; M. Rigby; Ch. Lincoln

doi:10.1055/s-2007-1014121

The Thoracic and Cardiovascular Surgeon, Table of Contents

Thorac Cardiovasc Surg 1985; 33(4): 210-214
DOI: 10.1055/s-2007-1014121

Morphological Observations following “Anatomical Correction” for Abnormal Ventriculo-arterial Connection

M. B. Rossi¹ , S. Y. Ho² , R. H. Anderson² , K. Kanter, M. Rigby, Ch. Lincoln

Department of Pediatrics, Cardiothoracic Institute and Department of Surgery, Brompton Hospital, London, UK

1 Dr. M.B. Rossi is research fellow at the Department of Pediatrics, Cardiothoracic Institute from “Fundacao Faculdade Federal de Ciências Médicas de Porto Alegre” and is supported by “Coordenaço Aperfeiçoamento do Pessoal de Nivel Superior”, Education and Culture Ministry of Brazil; 2 Dr. S.Y. Ho and Prof. R.H. Anderson are supported by the British Heart Foundation together with the Joseph Levy Foundation

Abstract

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Summary

Seven postmortem hearts from children who underwent anatomical correction for complete transposition (6 cases) and double outlet right ventricle (1 case) were examined in Order to gain a better understanding of the pathological morphology in relation to the surgical procedure. Associated malformations were ventricular septal defect in all, patent arterial duct in 4 and aortic coarctation in 3. In all hearts the coronary arteries arose from the facing aortic sinuses and were relocated into the facing sinuses of the pulmonary trunk with minimal displacement. The orifices of the coronary arteries were reduced in caliber in one case. The sinus node artery arising from a lateral atrial artery was transected in one case. The Lecompte maneuver was performed in 4 cases and tension on the pulmonary trunk was observed in 2 cases. Potential right ventricular outflow tract obstruction was evident in all (including one in which it had been resected during surgery). The Substrates of obstruction were anomalous parietal insertion of the outlet septum (2 cases), anomalous muscular trabeculation (1 case), rightward displacement of the outlet septum (1 case), parietal insertion of the outlet septum (1 case) and restrictive muscular infundibulum (1 case - DORV). In addition, all the complete transposition cases had hypertrophy of the parietal right ventricular wall. This study highlighted the anatomical features which could lead to poor results in the anatomical correction procedure. Some of the Potential problems could be avoided by minor modifications to the technique.

Key words

Complete transposition - Double outlet right ventricle - Anatomical correction

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