Staged Palliation of Cyanotic Obstructive Lesions With a Modified Right Ventricular Outflow Procedure

Batlivala, Sarosh P.; Hood, Mary K; Dodge-Khatami, Jannika; Shakti, Divya; Taylor, Mary; Ebeid, Makram R.; Salazar, Jorge D.; Dodge‐Khatami, Ali

doi:10.1177/2150135117738007

Cited by 3 publications

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“…As the key is the maintenance of cardiac output (= stroke volume × heart rate), the increase in cardiac output results in increased oxygen delivery, despite a lower systemic oxygen saturation. Based on the above considerations, in our clinical practice, we always leave a fenestrated interatrial communication (Figure 4), 3 or 4 mm diameter accordingly to body weight of the infant, in all surgical procedures involving extensive repairs of the right heart: tetralogy of Fallot, tetralogy of Fallot with absent pulmonary valve, Ebstein's anomaly, pulmonary atresia with ventricular septal defect, double outlet right ventricle with ventricular septal defect and right ventricular outflow tract obstruction, palliative reconstructions of the right ventricular outflow tract for cyanotic congenital heart defects 34.…”

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Modern advances regarding interatrial communication in congenital heart defects

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et al. 2021

Journal of Cardiac Surgery

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Background:The interatrial communication, one of the most frequent congenital heart defects, represents an important intracardiac shunt between systemic and pulmonary circulations. Direction and magnitude of the interatrial shunting depends upon several features, including defect size, shape and location, pressure difference between right and left atrium, and difference in right and left ventricular compliance.Methods: In this review article, the presence or absence of interatrial communication, and its role, have been analyzed, as they can have a critical impact on the cardiovascular physiopathology, and the interatrial communication can prove to be either clinically harmful, useful or indispensable. Accordingly, the utility and role of the interatrial communication in modern congenital, pediatric and adult, disease has evolved, with modification of the indications to close, maintain patency, or create an interatrial communication. Results:The interatrial communication and shunting can be manipulated to maximize the oxygen delivery to the tissues, accordingly with the underlying congenital heart defect.While not always relevant to patients with bi-ventricular circulations, this becomes extremely important in children and adults with complex congenital heart defects.Conclusions: With improving long-term survival for the vast majority of congenital heart patients, an advanced understanding of the role and utility of the interatrial communication, and of all the possibilities of its manipulation, is essential to improve the patient outcomes.

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confidence: 99%