How I Do It: A Versatile Curved Baffle Technique For Repair Of Complex Double Outlet Right Ventricle Nicholas D. Andersen, MD, Karl Reyes, MD, Ryan R. Davies, MD. Children's Health Dallas / UTSW, Dallas, TX, USA.
Introduction: This video presentation demonstrates a simple, versatile technique for repair of complex forms of double outlet right ventricle (DORV) using a curved three-dimensional left ventricle (LV) to aorta baffle. Description: Two cases of complex DORV repair are shown, including DORV with transposition, pulmonary stenosis, and a remote inlet ventricular septal defect (VSD) and a case of complex heterotaxy with total anomalous pulmonary venous return, pulmonary atresia, and DORV with a balanced complete atrioventricular canal defect. Cardiac magnetic resonance imaging with virtual 3-dimensional model generation was used to plan the LV to aorta tunnel construction. The LV to aorta tunnel was constructed from a linearized Dacron graft, based on specific length and size measurements, with the goal of creating a tunnel equal in size to the VSD. In the first case with septated atrioventricular valves, baffle creation was completed using a single graft via a right ventriculotomy approach. In the second case with an atrioventricular septal defect, a two-patch approach was used, including initial valve septation with an inlet VSD patch, followed by LV to aorta tunnel creation via right ventriculotomy using the curved baffle technique. Conclusions: A relatively simple curved baffle technique using a linearized Dacron graft can provide a versatile solution for repair of complex forms of DORV. Since adopting this technique, we have had no cases of return to bypass, or early or late re-intervention for residual VSD or baffle obstruction following all forms of complex DORV repair (n = 15).
