Surgical Palliation in Single Ventricle Patients with Dextrocardia

Long-term outcomes of single-ventricle palliation for unbalanced atrioventricular septal defects: Fontan survivors do better than previously thought

“…[2][3][4][5] Heterotaxy has been previously described as a risk factor for the Fontan operation. 9,19,20 Despite the associated challenges, there is evidence of recent improved outcomes in patients with heterotaxy syndrome undergoing the Fontan operation. 20,21 The majority of our patients (73%; 102 of 139) had heterotaxy, making it difficult to assess the true impact of heterotaxy per se in patients with uAVSD.…”

Discussion

“…We have recently demonstrated that patients with dextrocardia with single ventricle palliation had poor long-term outcomes, although this parameter had not been previously identified as a predictor of mortality. 14 In our study, we identified that 85% of patients with dextrocardia and atrial isomerism had atrioventricular regurgitation at the time of presentation. It is possible that the technical difficulty of achieving a sustainable repair in these patients contributed to their mortality.…”

Flow Dynamics of Bilateral Superior Cavopulomonary Shunts Influence Outcomes After Fontan Completion

“…Although Azakie et al showed improved Fontan procedure outcomes in patients with heterotaxy, the authors indicated that these patients still face risks [12]. Poh et al reported poor surgical outcomes with respect to single-ventricle palliation in patients with dextrocardia [17]. The unique hemodynamics imposed by a bilateral BCPS may offer yet another explanation for such findings, as our results indicate that abnormalities pertaining to certain flow dynamics-related and laboratory parameters, such as higher preoperative PA pressures, elevated LAP, and increased hemoglobin levels, can occur at the time of TCPC in patients who have undergone bilateral BCPS.…”