Double Outlet Left Ventricle

aorta main pulmonary artery main left coronary artery right coronary artery

Conduit Placement Ventricle Aorta

aortic valve pulmonary valve ventricular septum ventricular septal defect

Figure 10-11. After cardiopulmonary bypass is established, with aortic clamping, cardioplegia, and profound local cardiac cooling, a high right ventriculotomy is made transversely in anticipation of placement of an extracardiac conduit. The aortic valve is posterior and rightward, while the pulmonary valve is to the child's left. Both valves are seen through the VSD and are on the left ventricular side of the septum.

Figure 10-10. In this child, double outlet left ventricle is associated with an anomalous right coronary artery that arises from the main left coronary artery and courses on the surface of the upper right ventricle.

aortic valve pulmonary valve ventricular septum ventricular septal defect

Figure 10-11. After cardiopulmonary bypass is established, with aortic clamping, cardioplegia, and profound local cardiac cooling, a high right ventriculotomy is made transversely in anticipation of placement of an extracardiac conduit. The aortic valve is posterior and rightward, while the pulmonary valve is to the child's left. Both valves are seen through the VSD and are on the left ventricular side of the septum.

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Aortic Pulmonary Septum

pulmonary valve common annulus aortic valve fibrous tissue remnant of membranous septum anterior leaf of tricuspid valve

Figure 10-12. The ventricular septum is retracted anteriorly and the common annulus between the pulmonary and aortic valves is seen. A fibrous tissue remnant of underdeveloped membranous ventricular septum is seen at the posterior inferior corner of the VSD adjacent to the tricuspid valve leaflet. Repair stitches can be safely placed in this fibrous tissue and in the base of the anterior tricuspid valve leaflet to avoid damage to the His' bundle. Multiple interrupted felted mattress sutures will be used for the repair, starting at the posterior inferior rim of the ventricular septal defect. Stitches will be placed around the rim of the VSD to the left of the common annulus and between the pulmonary and aortic valve annuli toward the patient's right.

pulmonary valve common annulus aortic valve oaud fibrous tissue remnant of membranous septum anterior leaf of tricuspid valve

Figure 10-12. The ventricular septum is retracted anteriorly and the common annulus between the pulmonary and aortic valves is seen. A fibrous tissue remnant of underdeveloped membranous ventricular septum is seen at the posterior inferior corner of the VSD adjacent to the tricuspid valve leaflet. Repair stitches can be safely placed in this fibrous tissue and in the base of the anterior tricuspid valve leaflet to avoid damage to the His' bundle. Multiple interrupted felted mattress sutures will be used for the repair, starting at the posterior inferior rim of the ventricular septal defect. Stitches will be placed around the rim of the VSD to the left of the common annulus and between the pulmonary and aortic valve annuli toward the patient's right.

pulmonary valve

Figure 10-13. Stitches are placed in the rectangular-shaped knitted Dacron® patch and tied. The length of the rectangular patch is placed from side to side to cover the VSD and the aortic valve. The pulmonary valve remains on the right ventricular side of the patch.

pulmonary valve

Figure 10-13. Stitches are placed in the rectangular-shaped knitted Dacron® patch and tied. The length of the rectangular patch is placed from side to side to cover the VSD and the aortic valve. The pulmonary valve remains on the right ventricular side of the patch.

Double Outlet Right Ventricle

Figure 10-14. To avoid right ventricular outflow tract obstruction caused by the large intraventricular baffle, a porcine-valved Dacron® conduit is placed from the ventriculotomy to the main pulmonary artery. The integrity of the right coronary artery is maintained.

porcine valved Dacron conduit

Figure 10-14. To avoid right ventricular outflow tract obstruction caused by the large intraventricular baffle, a porcine-valved Dacron® conduit is placed from the ventriculotomy to the main pulmonary artery. The integrity of the right coronary artery is maintained.

Left Main Artery Blockage Pictures

main pulmonary artery aorta

Figure 10-15. In another patient, the great vessels are normally related, but the proximal main pulmonary artery is in a more posterior location.

main pulmonary artery aorta

Figure 10-15. In another patient, the great vessels are normally related, but the proximal main pulmonary artery is in a more posterior location.

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ventricular septum ventricular septal defect

Figure 10-16. After cardiopulmonary bypass is established and with aortic clamping, cardioplegia, and profound local cardiac cooling, a high longitudinal right ventriculotomy is made. The VSD is seen, but neither semilunar valve is related to the right ventricle. Only ventricular septum is seen in the cephalad region of the right ventricle because the pulmonary valve is not found here.

ventricular septum ventricular septal defect caud

Figure 10-16. After cardiopulmonary bypass is established and with aortic clamping, cardioplegia, and profound local cardiac cooling, a high longitudinal right ventriculotomy is made. The VSD is seen, but neither semilunar valve is related to the right ventricle. Only ventricular septum is seen in the cephalad region of the right ventricle because the pulmonary valve is not found here.

Aortic And Pulmonic Areas

upper infundlbulum area of pulmonic and aortic valve

Figure 10-17. The ventricular septum is retracted, and the blind end of the right ventricular infundibulum is seen. The pulmonic and aortic valves are on the left ventricular side of the septum.

upper infundlbulum area of pulmonic and aortic valve

Figure 10-17. The ventricular septum is retracted, and the blind end of the right ventricular infundibulum is seen. The pulmonic and aortic valves are on the left ventricular side of the septum.

Aortic And Pulmonic Areas

pulmonic valve right ventriculotomy

Figure 10-18. A longitudinal main pulmonary arteriotomy is made and the pulmonic valve is seen. An instrument placed through the valve passes into the left ventricle to confirm the presence of the double outlet left ventricle.

pulmonic valve right ventriculotomy

Figure 10-18. A longitudinal main pulmonary arteriotomy is made and the pulmonic valve is seen. An instrument placed through the valve passes into the left ventricle to confirm the presence of the double outlet left ventricle.

Aortic And Pulmonic Areas

area of common annulus of aortic and pulmonic valves baffle patch area of common annulus of aortic and pulmonic valves baffle patch caud

Figure 10-19. The ventriculotomy is extended to the pulmonary arteriotomy. Multiple interrupted felted mattress sutures are placed around the rim of the VSD. In the cepha-lad area, these stitches are placed in the common annulus of the semilunar valves, while, to the patient's right, stitches are placed in front of the aortic valve annulus. A rectangular-shaped Dacron® patch is then positioned to construct the intraventricular baffle. The right ventricular outflow tract will be reconstructed with a patch over the ventriculotomy and the proximal main pulmonary artery.

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Figure 10-19. The ventriculotomy is extended to the pulmonary arteriotomy. Multiple interrupted felted mattress sutures are placed around the rim of the VSD. In the cepha-lad area, these stitches are placed in the common annulus of the semilunar valves, while, to the patient's right, stitches are placed in front of the aortic valve annulus. A rectangular-shaped Dacron® patch is then positioned to construct the intraventricular baffle. The right ventricular outflow tract will be reconstructed with a patch over the ventriculotomy and the proximal main pulmonary artery.

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Blood Pressure Health

Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

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