Double-outlet right ventricle with non-committed ventricular septal defect

Objective. The term non-committed was used to define hearts in which the VS D was anatomically related to, or was close to, neither great vessel, being separated from both by considerable muscle. We report our experience of th e surgical management of this subset, considered being of particular surgic al relevance. Methods: Between January 1987 and December 1997, 23 patients having double-outlet right ventricle (DORV) with non-committed VSD underwen t biventricular repair. Nine (39%) had undergone previous palliation. The m edian age was 20 months and the median weight was 8.5 kg. Two main types of repair were used: intraventricular baffle repair (n = 21) and arterial swi tch operation with VSD to pulmonary artery baffle (n = 2). At repair, 12 (5 2%) patients required concomitant VSD enlargement. In two other patients pr esenting with restrictive inlet VSD associated with tricuspid attachments, crossing the subaortic pathway biventricular repair was abandoned at operat ion. Results: There were two hospital deaths (9%, 70% CL: 3-19%). Eight pat ients (35%, 70% CL: 23-48%) underwent nine reoperation, six for subaortic s tenosis. No late death occurred. At last visit, all patients were asymptoma tic and only two had cardiac medication. Conclusions: The biventricular rep air of DORV with non-committed VSD is feasible in the vast majority of case s with comparable results to other subsets of DORV. After repair, the subao rtic region is at risk for development of subaortic stenosis. (C) 1999 Else vier Science B.V. All rights reserved.