How I Do It: Ventricular Switch For Two-ventricle Univentricular Physiology -using The Left Ventricle As The Sub-pulmonary Ventricle
Hani K. Najm, MD, MSc, Tara Karamlou, Munir Ahmad, MD, Bob Stewart, MD, Malek Yaman, MD, Saad Hassan, MD, Gosta Pettersson, MD, PhD.
Cleveland Clinic, Cleveland, OH, USA.
Background: Complex congenital heart disease in which the left ventricle (LV) cannot be routed to the aorta has been triaged to single ventricle palliation and labeled as â€œunseptatableâ€?. This video demonstrates successful biventricular (BiV) septation, termed ventricular switch (VS), utilizing (LV) as the subpulmonary ventricle. Video Summary: 31-year old male with heterotaxia, asplenia, double-outlet right ventricle with complete atrioventricular septal defect, D-malposed great vessels, pulmonary stenosis, total anomalous pulmonary venous (PV) connection to left superior vena cava (SVC) , bilateral SVCs , and separate hepatic vein entrance to the morphologic right atrium , presented with severe cyanosis and exercise intolerance. 3D printed model (Figure) confirmed inability to route the LV to the aorta, but he was thought to be a candidate for VS. Surgical sequence included: 1) Common AVV division and VSD patch closure; 2) Detachment of PV confluence from left SVC and connection to the right-sided atrium; 3) Atrial conversion using inter-atrial autologous pericardial patch-baffle directing PV blood to PV atrium and right AVV, and routing the inferior vena cava (IVC) and hepatic veins to the LAVV; 4) Anastomosis of right SVC to left SVC behind the aorta; 5) LV-pulmonary artery conduit insertion (28 Dacron tube with in-situ 25 mm porcine valve). Postoperative convalescence was uncomplicated, with 10-day hospital stay. At 7 months following VS, his systemic saturation is 94% with normal exercise tolerance.