PMID- 12238840
OWN - NLM
STAT- MEDLINE
DCOM- 20021001
LR  - 20190628
IS  - 0003-4975 (Print)
IS  - 0003-4975 (Linking)
VI  - 74
IP  - 3
DP  - 2002 Sep
TI  - Management and outcome of patients with abnormal ventriculo-arterial connections 
      and mitral valve cleft.
PG  - 786-91
AB  - BACKGROUND: In patients with abnormal ventriculo-arterial connections, a mitral 
      valve cleft different from an atrioventricular canal is occasionally associated. 
      It may cause outflow obstruction, mitral regurgitation, and complicate 
      biventricular repair. METHODS: A retrospective review identified 21 patients 
      operated upon with mitral valve cleft, abnormal ventriculo-arterial connections, 
      and two well-developed ventricles. Eight patients had a ventricular outflow 
      obstruction due to the mitral valve, whereas 2 had more than mild mitral 
      regurgitation. One patient required initial mitral valve surgery. Eleven patients 
      underwent biventricular repair, associated with mitral valve repair in 2 cases: 
      arterial switch operation (n = 4), Senning operation (n = 3) associated with an 
      arterial switch operation in one case, intraventricular repair (n = 3), and 
      Rastelli-type extracardiac conduit repair (n = 1). Single-ventricle palliation 
      was preferred in 10 patients with major mitral valve straddling (n = 5), outflow 
      tract obstruction (n = 2), and noncommitted or multiple VSDs (n = 3). RESULTS: 
      There were three hospital deaths, two of which occurred after biventricular 
      repair and one after an early reoperation after a bidirectional cavopulmonary 
      anastomosis. Postoperatively after biventricular repair, 1 patient required 
      permanent pacemaker implantation and 3 patients were reoperated on for subaortic 
      stenosis (n = 1) and mitral regurgitation (n = 2), with one late death. By 
      multivariate analysis, patients with a double-outlet right ventricle were at 
      greater risk of death (p = 0.04). After a mean follow-up period of 60.7 months 
      (+/- 68.6 months), 16 patients are in New York Heart Association (NYHA) class I. 
      One patient with a moderate mitral regurgitation on Doppler study is in NYHA 
      class II. CONCLUSIONS: The surgical management remains controversial in patients 
      with abnormal ventriculo-arterial connections and mitral valve cleft. 
      Biventricular repair may not always be feasible, especially in cases of complex 
      intracardiac anatomy associated with mitral valve straddling. Single-ventricle 
      palliation can be achieved in these patients, although it is unknown whether the 
      long-term results are as good as those obtained with biventricular repair.
FAU - Fraisse, Alain
AU  - Fraisse A
AD  - Service de Cardiologie Pediatrique, Hopital Necker Enfants Malades, Paris, 
      France. afraisse@mail.ap-hm.fr
FAU - Massih, Tony Abdel
AU  - Massih TA
FAU - Vouhe, Pascal
AU  - Vouhe P
FAU - Kreitmann, Bernard
AU  - Kreitmann B
FAU - Gaudart, Jean
AU  - Gaudart J
FAU - Sidi, Daniel
AU  - Sidi D
FAU - Bonnet, Damien
AU  - Bonnet D
LA  - eng
PT  - Journal Article
PL  - Netherlands
TA  - Ann Thorac Surg
JT  - The Annals of thoracic surgery
JID - 15030100R
SB  - IM
MH  - Adolescent
MH  - Cause of Death
MH  - Child
MH  - Child, Preschool
MH  - Female
MH  - Heart Defects, Congenital/mortality/*surgery
MH  - Hospital Mortality
MH  - Humans
MH  - Infant
MH  - Infant, Newborn
MH  - Male
MH  - Mitral Valve/*abnormalities/surgery
MH  - Postoperative Complications/mortality
MH  - Reoperation/mortality
MH  - Retrospective Studies
MH  - Ventricular Outflow Obstruction/*congenital/mortality/surgery
EDAT- 2002/09/20 10:00
MHDA- 2002/10/03 04:00
CRDT- 2002/09/20 10:00
PHST- 2002/09/20 10:00 [pubmed]
PHST- 2002/10/03 04:00 [medline]
PHST- 2002/09/20 10:00 [entrez]
AID - S0003-4975(02)03743-8 [pii]
AID - 10.1016/s0003-4975(02)03743-8 [doi]
PST - ppublish
SO  - Ann Thorac Surg. 2002 Sep;74(3):786-91. doi: 10.1016/s0003-4975(02)03743-8.