A practical approach to 1 1/2 ventricle repairs.
BACKGROUND
Perioperative and long-term problems associated with the Fontan circulation are substantial. There has been an exploration of extending the limits of a biventricular ventricular repair by using a superior vena cava-to-pulmonary artery anastomosis. This type of repair is known as a 1 1/2 ventricle repair.


METHODS
Patients having defects of the pulmonary ventricle in size or function have undergone 1 1/2 ventricle repairs with or without creation of an atrial septal defect. Repairs with tricuspid z values as small as -10 and predicted pulmonary ventricular volumes as low as 30% have been reported. The 1 1/2 ventricle repair technique has also been used in special situations associated with an arterial switch or double switch procedure.


RESULTS
Mortality has ranged from 0% to 12%. Complications have included persistent elevation of superior vena cava pressure, intermittent periorbital edema, and 1 superior vena caval aneurysm requiring takedown. There appears to be an increased risk of perioperative pleural effusions and chylothorax. Protein-losing enteropathy and chronic atrial arrhythmias have not been present.


CONCLUSIONS
Successful 1 1/2 ventricle repairs have been reported for morphologically small or poorly functioning pulmonary ventricles and special situations. Intermediate-term follow-up is favorable when compared with reported outcomes for the Fontan circulation.
Van Arsdell
G S
GS
Division of Cardiac Surgery, The Hospital for Sick Children, University of Toronto, Ont, Canada.
Williams
W G
WG
Freedom
R M
RM
D000714:Anastomosis, Surgical; D006330:Heart Defects, Congenital / Q000601:surgery; D006352:Heart Ventricles / Q000601:surgery*; D006801:Humans; D011651:Pulmonary Artery / Q000601:surgery*; D014683:Vena Cava, Superior / Q000601:surgery*