Publication Date
8-1-2017
Journal
The Texas Heart Journal
DOI
10.14503/THIJ-16-5759
PMID
28878577
Publication Date(s)
August 2017
Language
English
PMCID
PMC5577949
PubMedCentral® Posted Date
8-1-2017
PubMedCentral® Full Text Version
Post-Print
Published Open-Access
yes
Keywords
Abnormalities, multiple/diagnostic imaging; cardiac surgical procedures; double-outlet right ventricle/complications/diagnostic imaging/surgery; echocardiography; heart defects, congenital/classification/surgery; heart septal defects, ventricular/classification/complications/surgery; retrospective studies; transposition of great vessels/classification/surgery; treatment outcome; ventricular outflow obstruction/surgery
Copyright
This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.
Abstract
Selecting an appropriate surgical approach for double-outlet right ventricle (DORV), a complex congenital cardiac malformation with many anatomic variations, is difficult. Therefore, we determined the feasibility of using an echocardiographic classification system, which describes the anatomic variations in more precise terms than the current system does, to determine whether it could help direct surgical plans. Our system includes 8 DORV subtypes, categorized according to 3 factors: the relative positions of the great arteries (normal or abnormal), the relationship between the great arteries and the ventricular septal defect (committed or noncommitted), and the presence or absence of right ventricular outflow tract obstruction (RVOTO). Surgical approaches in 407 patients were based on their DORV subtype, as determined by echocardiography. We found that the optimal surgical management of patients classified as normal/committed/no RVOTO, normal/committed/RVOTO, and abnormal/committed/no RVOTO was, respectively, like that for patients with large ventricular septal defects, tetralogy of Fallot, and transposition of the great arteries without RVOTO. Patients with abnormal/committed/RVOTO anatomy and those with abnormal/noncommitted/RVOTO anatomy underwent intraventricular repair and double-root translocation. For patients with other types of DORV, choosing the appropriate surgical approach and biventricular repair techniques was more complex. We think that our classification system accurately groups DORV patients and enables surgeons to select the best approach for each patient's cardiac anatomy.