The feasibility of complete anatomical correction in the setting of discordant atrioventricular connections

Objective-To evaluate the feasibility of anatomical correction based on mor phological and echocardiographic findings in patients and preserved hearts with discordant atrioventricular connections. Design-A retrospective study with clinicomorphological correlations to asse ss potential contraindications for anatomical correction in the setting of discordant atrioventricular connections. Setting-A tertiary referral centre for congenital heart disease. Material-2 5 specimens and 53 patients unified by presence of discordant atrioventricu lar connections. Methods-The potential contraindications for anatomical correction were firs t evaluated on the basis of morphological findings in all 25 specimens with discordant atrioventricular connections collected in the department museum , including study of the major coronary arterial patterns in 20. These cont raindications were then sought in a population of 53 patients examined echo cardiographically between January 1992 and October 1997. Results-At least one lesion was discovered that might have contraindicated anatomical correction in 14 of the specimens and in 16 of the patients. The most common lesions that might militate against the anatomical approach we re severe Ebstein's malformation or straddling and overriding of the tricus pid valve, each when combined with hypoplasia of the morphologically right ventricle. Other potential contraindications were atrioventricular septal d efect with common atrioventricular junction, and obstruction of the left ve ntricular outlet combined with a restrictive ventricular septal defect, alt hough these may be overcome with increasing experience and expertise. Conclusions-According to the morphological and echocardiographic findings, at least 10 hearts and 37 patients would have produced no anatomical proble ms for the type of surgical correction in which the morphologically left ve ntricle is restored its rightful role as the systemic pumping chamber.