Infundibular Stenosis and Double Chamber Right Ventricle

Repair is performed with cardiopulmonary bypass, aortic clamping, cardioplegic arrest, and profound local cardiac cooling.

valve caud

Figure 7-3. In this patient, after cardiopulmonary bypass is established, a proximal main pulmonary arteriotomy is made. There are three leaflets with stenotic commissures, and the valve is dysplastic. All leaflets are fibrous with limited mobility. Incising the stenotic commissures alone will not relieve the obstruction, because the leaflets are bulky and will not adequately move out of the stream of blood during systole. Part or all of the leaflets will be resected to avoid residual obstruction.

Double Chamber Right Ventricle

Figure 7-4. After the child is placed on cardiopulmonary bypass, a high right ventriculotomy is made. Obstruction at the os infundibulum is identified. There are large muscle ridges in the region of the parietal and septal bands extending to the anterior wall of the right ventricle. Fibrous tissue surrounds the os.

Figure 7-4. After the child is placed on cardiopulmonary bypass, a high right ventriculotomy is made. Obstruction at the os infundibulum is identified. There are large muscle ridges in the region of the parietal and septal bands extending to the anterior wall of the right ventricle. Fibrous tissue surrounds the os.

caud

Infundibular Muscle Resection

os infundibulum tricuspid valve papillary muscle

Figure 7-5. Obstructing muscle and fibrous tissue has been resected, and the tricuspid apparatus below this area is seen.

os infundibulum tricuspid valve papillary muscle caud

Figure 7-5. Obstructing muscle and fibrous tissue has been resected, and the tricuspid apparatus below this area is seen.

Double Chamber Right Ventricle

parietal band moderator band

Figure 7-6. Double-chambered right ventricle is a form of infundibular pulmonary stenosis caused by muscle obstruction that is primarily in the area of the moderator band, as seen on this right ventriculogram.

parietal band moderator band

Figure 7-6. Double-chambered right ventricle is a form of infundibular pulmonary stenosis caused by muscle obstruction that is primarily in the area of the moderator band, as seen on this right ventriculogram.

Double Chamber Right Ventricle

parietal band moderator band tricuspid valve leaflets

Figure 7-7. In this patient with double chamber right ventricle the exposure is through a right atriotomy while the tricuspid valve is retracted. The hypertrophied moderator band forms the major blockage, although an obstructing parietal band is also seen.

parietal band moderator band

Figure 7-7. In this patient with double chamber right ventricle the exposure is through a right atriotomy while the tricuspid valve is retracted. The hypertrophied moderator band forms the major blockage, although an obstructing parietal band is also seen.

tricuspid valve leaflets

Double Chamber Right Ventricle

parieta band

Figure 7-8. An associated membranous ventricular septal defect (VSD) is located medial to the parietal band.

parieta band

Figure 7-8. An associated membranous ventricular septal defect (VSD) is located medial to the parietal band.

Right Ventricular Infundibulum Resection
Figure 7-9. The parietal and moderator bands are resected, and the os infundibulum is now open. The VSD is closed with multiple interrupted mattress sutures and a Dacron® patch.

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