title: Two-ventricle repair for complex congenital heart defects palliated towards single-ventricle repair.
abstract: OBJECTIVE
  Complex congenital heart defects that present earlier in life are sometimes channelled towards single-ventricle repair, because of anatomical or logistic challenges involved in two-ventricle correction. Given the long-term functional and survival advantage, we have been consciously exploring the feasibility of a biventricular repair in these patients when they present later for Fontan completion.
  
  
  METHODS
  Since June 2009, 71 patients were referred for staged completion of the Fontan procedure. Following detailed evaluation that included three-dimensional echocardiography and magnetic resonance imaging, 10 patients (Group 1-median age 6 years) were identified and later underwent complex biventricular repair with takedown of Glenn shunt, while completion of extracardiac Fontan repair was done in 61 patients (Group 2-median age 7 years).
  
  
  RESULTS
  Two-ventricle repair was accomplished in all the 10 Group 1 patients. One patient developed complete heart block requiring permanent pacemaker insertion. Late patch dehiscence occurred in another (awaiting repair). At a median follow-up of 15 months, there was no mortality among the Group 1 patients and all except for 1 patient were symptom free. There were 2 early deaths (3.3%) in the Group 2 patients.
  
  
  CONCLUSIONS
  Two-ventricular repair, although surgically challenging, should be considered in all patients with two functional ventricles who come for Fontan completion. Comprehensive preoperative imaging and meticulous planning helps in identifying suitable candidates.
authors: Department of Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
authors: Brijesh P
authors: BP
authors: Kottayil
authors: Gopalraj S
authors: GS
authors: Sunil
authors: Mahesh
authors: M
authors: Kappanayil
authors: Sweta Harish
authors: SH
authors: Mohanty
authors: Edwin
authors: E
authors: Francis
authors: Balu
authors: B
authors: Vaidyanathan
authors: Rakhi
authors: R
authors: Balachandran
authors: Suresh G
authors: SG
authors: Nair
authors: Raman Krishna
authors: RK
authors: Kumar
mesh_terms: D002648:Child; D002675:Child, Preschool; D019560:Echocardiography, Three-Dimensional; D005240:Feasibility Studies; D018729:Fontan Procedure / Q000009:adverse effects / Q000401:mortality; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006352:Heart Ventricles / Q000002:abnormalities / Q000601:surgery*; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D010166:Palliative Care; D018579:Patient Selection; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Bidirectional Glenn shunt; Congenital heart disease; Univentricular heart; Ventricle