title: Total right ventricular exclusion procedure: an operation for isolated congestive right ventricular failure.
abstract: OBJECTIVE
  To prevent possible deleterious effects of right ventricular volume overload on cardiorespiratory function, we developed a total right ventricular exclusion procedure for the treatment of end-stage isolated congestive right ventricular failure.
  
  
  METHODS
  Since 1996, this procedure has been performed in 5 patients in New York Heart Association functional class IV: 2 adults with arrhythmogenic right ventricular dysplasia and 3 children with Ebstein anomaly. The entire right ventricular free wall was resected along the atrioventricular groove and then parallel to the interventricular septum, sparing the pulmonary valve and a skeletonized right coronary artery. The orifice of the tricuspid valve was closed with either a polytetrafluoroethylene patch or with its leaflets. The defect of the right ventricular free wall was covered with a polytetrafluoroethylene patch in the 2 patients with arrhythmogenic right ventricular dysplasia and directly closed with the remnant of the free wall in the 3 children with Ebstein anomaly. After resection of a redundant right atrial wall, coronary sinus blood flow was rerouted into the left atrium through an atrial septal defect. A total cavopulmonary connection was constructed in 4 patients and a bidirectional superior cavopulmonary anastomosis in 1 infant. The heart was controlled with a DDD pacemaker in 3 patients.
  
  
  RESULTS
  The patients were extubated at a mean of 14 hours postoperatively (range, 1-38 hours). There were no early or late deaths. At follow-up, ranging from 8 to 57 months, the mean cardiothoracic ratio had decreased from 74% +/- 7% before the operation to 52% +/- 6% (P <.01). All patients are in functional class I. Neither of the patients with arrhythmogenic right ventricular dysplasia have had attacks of ventricular tachycardia nor are they using antiarrhythmic medication.
  
  
  CONCLUSIONS
  The total right ventricular exclusion procedure provides effective decompression of the lung, as well as the left ventricle, and may result in more effective volume loading of a surgically created single ventricle with increased systemic output. We believe that this new surgical option offers rescue treatment for isolated end-stage right ventricular failure in critically ill patients.
authors: Department of Cardiovascular Surgery, Okayama University Medical School, Okayama, Japan. s_sano@cc.okayama-u.ac.jp
authors: Shunji
authors: S
authors: Sano
authors: Kozo
authors: K
authors: Ishino
authors: Masaaki
authors: M
authors: Kawada
authors: Shingo
authors: S
authors: Kasahara
authors: Takushi
authors: T
authors: Kohmoto
authors: Mamoru
authors: M
authors: Takeuchi
authors: Shin-Ichi
authors: S
authors: Ohtsuki
mesh_terms: D000328:Adult; D019571:Arrhythmogenic Right Ventricular Dysplasia / Q000150:complications / Q000628:therapy; D002669:Child Welfare; D002675:Child, Preschool; D004437:Ebstein Anomaly / Q000150:complications / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D018610:Heart Bypass, Right; D006333:Heart Failure / Q000150:complications / Q000601:surgery; D006352:Heart Ventricles / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D010138:Pacemaker, Artificial; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000150:complications / Q000628:therapy