Double Outlet Right Ventricle

main pulmonary artery ascending aorta

Figure 10-1. In this infant, the great vessels and semilunar valves are oriented side by side and at the same level.

Right Ventricle Septal Anatomy

pulmonary valve aortic valve ventricular septal defect

Figure 10-2. After placing the child on bypass with aortic clamping and cardioplegia, a high longitudinal right ventriculotomy is made and extended cephalad into the proximal main pulmonary artery. There is a common annulus between the semilunar valves and both arise from the right ventricle. The ventricular septal defect is subaortic.

pulmonary valve aortic valve ventricular septal defect

Figure 10-2. After placing the child on bypass with aortic clamping and cardioplegia, a high longitudinal right ventriculotomy is made and extended cephalad into the proximal main pulmonary artery. There is a common annulus between the semilunar valves and both arise from the right ventricle. The ventricular septal defect is subaortic.

Subaortic Vsd

ventricular septal defect ventricular septum ventricular septal defect ventricular septum

Figure 10-3. The ventricular septal defect (VSD) is restrictive and will be enlarged anteriorly or toward the infant's left.

Figure 10-3. The ventricular septal defect (VSD) is restrictive and will be enlarged anteriorly or toward the infant's left.

ventricular septal incision

ceph caud

Figure 10-4. The ventricular septum is incised in a more cephalad area and just below the pulmonary valve annulus, keeping the incision remote from the His bundle.

ceph caud

Figure 10-4. The ventricular septum is incised in a more cephalad area and just below the pulmonary valve annulus, keeping the incision remote from the His bundle.

Relation Between Vsd And Bundle His

pulmonary valve aortic valve ventricular septal defect

Figure 10-5. Interrupted felted mattress sutures are placed along the rim of the VSD. In the posterior inferior corner of the VSD, caution is used to avoid damage to the His bundle, similar to repair of tetralogy of Fallot. Working cephalad from this point, stitches are placed to the right of the aortic valve annulus and then along the cephalad rim of that annulus. In contradistinction to repair of tetralogy, there is a greater distance from the posterior inferior corner of the VSD to the upper right aspect of the aortic valve annulus. A greater number of sutures will be required in this area.

pulmonary valve aortic valve ventricular septal defect

Figure 10-5. Interrupted felted mattress sutures are placed along the rim of the VSD. In the posterior inferior corner of the VSD, caution is used to avoid damage to the His bundle, similar to repair of tetralogy of Fallot. Working cephalad from this point, stitches are placed to the right of the aortic valve annulus and then along the cephalad rim of that annulus. In contradistinction to repair of tetralogy, there is a greater distance from the posterior inferior corner of the VSD to the upper right aspect of the aortic valve annulus. A greater number of sutures will be required in this area.

caud

Dacron Gore Tex Patch Vsd

baffle patch

Figure 10-6. The Dacron® patch is cut in a somewhat rectangular shape that is needed to construct the tunnel from the VSD to the aortic valve. The longer part of the patch is positioned from left to right. A redundant patch is placed to avoid left ventricle to aortic obstruction. The aortic valve is now beneath the patch, while the pulmonary valve leaflets are on the right ventricular side of the patch.

baffle patch caud

Figure 10-6. The Dacron® patch is cut in a somewhat rectangular shape that is needed to construct the tunnel from the VSD to the aortic valve. The longer part of the patch is positioned from left to right. A redundant patch is placed to avoid left ventricle to aortic obstruction. The aortic valve is now beneath the patch, while the pulmonary valve leaflets are on the right ventricular side of the patch.

Double Outlet Right Ventricle

intra ventricular baffle

Figure 10-7. Stitches are tied as the patch is lowered into position. The upper margin of the patch will be attached directly to the common annulus between the semilunar valves or in the base of the pulmonary valve leaflets, being careful to avoid injury to the aortic valve leaflets.

intra ventricular baffle

Figure 10-7. Stitches are tied as the patch is lowered into position. The upper margin of the patch will be attached directly to the common annulus between the semilunar valves or in the base of the pulmonary valve leaflets, being careful to avoid injury to the aortic valve leaflets.

caud

Right Ventricular Pulmonary Tract

outflow tract patch

Figure 10-8. A Gore-Tex® patch is used to reconstruct the outflow tract in order to avoid right ventricular outlet obstruction caused by the bulging intraventricular baffle.

outflow tract patch caud

Figure 10-8. A Gore-Tex® patch is used to reconstruct the outflow tract in order to avoid right ventricular outlet obstruction caused by the bulging intraventricular baffle.

Insertion Outflow Tract Patch

outflow tract patch

Figure 10-9. The repair is complete with placement of the outflow tract patch.

outflow tract patch

Figure 10-9. The repair is complete with placement of the outflow tract patch.

Double Inlet Right Ventricle

aorta main pulmonary artery main left coronary artery right coronary artery

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.

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Responses

  • Joshua
    What procedure is it to repair Pulmunary Artery?
    7 years ago

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