PARTIAL BIVENTRICULAR REPAIR FOR COMPLEX CONGENITAL HEART-DEFECTS - AN INTERMEDIATE OPTION FOR COMPLICATED ANATOMY OR FUNCTIONALLY BORDERLINE RIGHT COMPLEX HEART

Background: Partial biventricular repair consists of bidirectional cav opulmonary anastomosis in the presence of separated systemic and pulmo nary circulations, with antegrade flow of inferior caval return throug h an intact or reconstructed pulmonary outflow tract. This versatile p rocedure may be used as a definitive repair for patients with a functi onal right heart complex incapable of supporting an entire cardiac out put or in patients with complicated anatomy. Methods: From July 1992 t o April 1997, 23 patients (median age 5.2 years) underwent partial biv entricular repair. In 15 of these cases the entire repair, including b idirectional cavopulmonary anastomosis, intracardiac repair, and right ventricular outflow reconstruction, was performed as a planned proced ure at our institution. The other eight patients had previously been p laced on a Fontan track and had undergone bidirectional cavopulmonary anastomosis; their circulations were converted to a partial biventricu lar circulation, Results: There were no early deaths. Complete atriove ntricular block developed in two patients with straddling tricuspid va lve. At a median follow-up of 17 months, there were no late deaths and three patients had undergone reintervention, Partitioning of the pulm onary arteries to create a classic Glenn anastomosis with antegrade fl ow to the left lung was performed in one case; another patient underwe nt an atrial septectomy, and the third patient required revision of tr icuspid valve repair. All patients are in New York Heart Association f unctional class I. Conclusions: Partial biventricular repair is a vers atile strategy that can be used to manage a variety of forms of comple x congenital heart disease. Cases for which the repair is useful inclu de those in which complete biventricular repair is unlikely to be achi eved because of limited size or function of the right side of the hear t and those in which a patient with a ventricle capable of supporting inferior vena caval return was previously placed on a Fontan track.