Pathologic substrates for 1 1/2 ventricular repair.

Abstract

BACKGROUND: The concept of "one and a half ventricular repair" relates to situations where one ventricle is capable of pumping one half of the circulation while the other ventricle is deemed inadequate and requires off-loading by means of a shunt. The inadequate ventricle is usually assigned the role of pumping the pulmonary circulation. The majority of hearts potentially amenable to this repair will have one large ventricle associated with a smaller and more-or-less rudimentary ventricle. METHODS: In this review, we focused on hearts in which the morphologically left ventricle will continue to support the systemic circulation. RESULTS: Among the hearts with univentricular atrioventricular connections, a few cases of classic tricuspid atresia and cases of double-inlet left ventricle coexisting with concordant ventriculoarterial connections would be suitable for incorporating the right ventricle into the pulmonary circulation. This procedure may be feasible in some cases of straddling and overriding tricuspid valve. Hearts with pulmonary atresia and intact ventricular septum display a wide range of sizes of the right ventricular cavity. Although biventricular repair is an option for those with good-sized cavities, patients with hypoplastic right ventricles may be candidates for one and a half ventricular repair. CONCLUSIONS: For the lesions reviewed, and many others, one and a half ventricular repair can be an option.