title: The feasibility of complete anatomical correction in the setting of discordant atrioventricular connections.
abstract: OBJECTIVE
  To evaluate the feasibility of anatomical correction based on morphological and echocardiographic findings in patients and preserved hearts with discordant atrioventricular connections.
  
  
  METHODS
  A retrospective study with clinicomorphological correlations to assess potential contraindications for anatomical correction in the setting of discordant atrioventricular connections.
  
  
  METHODS
  A tertiary referral centre for congenital heart disease.
  
  
  METHODS
  25 specimens and 53 patients unified by presence of discordant atrioventricular connections.
  
  
  METHODS
  The potential contraindications for anatomical correction were first evaluated on the basis of morphological findings in all 25 specimens with discordant atrioventricular connections collected in the department museum, including study of the major coronary arterial patterns in 20. These contraindications were then sought in a population of 53 patients examined echocardiographically between January 1992 and October 1997.
  
  
  RESULTS
  At least one lesion was discovered that might have contraindicated anatomical correction in 14 of the specimens and in 16 of the patients. The most common lesions that might militate against the anatomical approach were severe Ebstein's malformation or straddling and overriding of the tricuspid valve, each when combined with hypoplasia of the morphologically right ventricle. Other potential contraindications were atrioventricular septal defect with common atrioventricular junction, and obstruction of the left ventricular outlet combined with a restrictive ventricular septal defect, although these may be overcome with increasing experience and expertise.
  
  
  CONCLUSIONS
  According to the morphological and echocardiographic findings, at least 10 hearts and 37 patients would have produced no anatomical problems for the type of surgical correction in which the morphologically left ventricle is restored its rightful role as the systemic pumping chamber.
authors.affiliation: Paediatrics, National Heart and Lung Institute, Royal Brompton Campus, Imperial College School of Medicine, Dovehouse Street, London SW3 6LY, UK.
authors.forename: C
authors.initials: C
authors.lastname: Alva
authors.forename: E
authors.initials: E
authors.lastname: Horowitz
authors.forename: S Y
authors.initials: SY
authors.lastname: Ho
authors.forename: M L
authors.initials: ML
authors.lastname: Rigby
authors.forename: R H
authors.initials: RH
authors.lastname: Anderson
mesh_terms: D002675:Child, Preschool; D004452:Echocardiography; D005240:Feasibility Studies; D005260:Female; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D008297:Male; D012189:Retrospective Studies