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Right arrow Congenital - cyanotic

J Thorac Cardiovasc Surg 2002;124:442-447
© 2002 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease (CHD)

Septation of the single ventricle: Revisited

Renee E. Margossian, MDa, David Solowiejczyk, MDa, Francois Bourlon, MDc, Howard Apfel, MDa, Welton M. Gersony, MDa, Allan J. Hordof, MDa, Jan Quaegebeur, MDb,c

From the New York Presbyterian Hospital-Columbia University, the Divisions of Pediatric Cardiologya and Pediatric Cardiothoracic Surgery,b New York, NY, and the Cardiothoracic Centre of Monaco.c

Received for publication March 30, 2001. Revisions requested June 14, 2001; revisions received Oct 15, 2001. Accepted for publication Nov 19, 2001. Address for reprints: Renee Margossian, MD, Department of Cardiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115 (E-mail: reneem{at}cardio.tch.harvard.edu).

Background: Septation of a single ventricle into 2 functioning ventricles can provide an alternative to the Fontan operation. However, early experiences with septation reported unacceptable morbidity and mortality. The present study selected only those patients with large volume-overloaded hearts, 2 well-functioning atrioventricular valves, and an absence of severe outlet obstruction. Early and intermediate outcomes are evaluated.
Methods and Results: Between June 1990 and March 1999, 11 patients underwent septation in 1 or 2 stages. Diagnoses of the patients included double-inlet left ventricle in 9, double-inlet right ventricle in 1 patient, and indeterminate ventricle in 1 patient. Five had L-transposition and 3 had D-transposition of the great arteries. Six had septation as 1 stage, 5 as planned 2-stage operations (2/5 completed). The median age for septation in 1 stage was 2.1 years (range 4 months to 5.8 years); for 2 stages, the median age was 7.2 months (range 3 to 14 months). Median follow-up time was 2.3 years. Eight of 11 patients survived (73%), with 2 early deaths and 1 late death. Seven of the 8 survivors have undergone complete septation (5 as single stage, 2 as 2 stages). Complications included surgically induced complete atrioventricular block in 1 patient and significant residual ventricular septal defects in another. Qualitatively, left ventricular function by echocardiography is normal in all patients, whereas right ventricular function is mildly decreased in 1 patient. All patients are clinically well.
Conclusion: The septation procedure for single ventricle hearts may be a reasonable alternative to the Fontan operation in selected patients.






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