Total Right Ventricular Exclusion Improves Left Ventricular Function in Patients With End-Stage Congestive Right Ventricular Failure

Abstract

Background-We developed a total right ventricular (RV) exclusion procedure for the treatment of isolated congestive RV failure. The objective of the present study was to elucidate the effects of a complete removal of RV volume overload (RVVO) on the surgically created single left ventricle (LV). Methods and Results-Three adults (2 arrhythmogenic RV dysplasia, 1 Ebstein) and 5 children (all Ebstein) in NYHA class IV underwent the procedure. The RV free wall was resected from the heart, and the tricuspid orifice was closed. Pulmonary blood supply was obtained by a cavopulmonary connection in 6 patients and a systemic-pulmonary shunt in 2. The LV function was evaluated by 2-dimensional echocardiography 1 month after the surgery. All patients are alive. The paradoxical movement of the interventricular septum and geometry of the LV expressed by its eccentricity (2.

Cavopulmonary anastomosis improves left ventricular assist device support in acute biventricular failure☆☆☆

“…The use of the surgical exclusion of the right ventricle in the treatment of isolated right ventricular dysfunction has been reported in experimental [17] and clinical studies [9][10][11]18]. Classical or modified Glenn connection seems to be capable of adequately maintaining the pulmonary circulation in the presence of right ventricular failure, as also observed in our model of biventricular collapse.…”

“…Classical or modified Glenn connection seems to be capable of adequately maintaining the pulmonary circulation in the presence of right ventricular failure, as also observed in our model of biventricular collapse. Right ventricular exclusion also seems to attenuate the left ventricular dysfunction by limiting right ventricular dilation, and restoring interventricular septal position and left ventricular cavity shape, as suggested by some authors [17,18]. In this regard, the decrease of right ventricular pressure overloading observed with cavopulmonary anastomosis is encouraging and opens a good perspective for the use of this surgical approach as a bridge to myocardial function recovery.…”

A modified Glenn shunt improves haemodynamics in acute right ventricular failure in an experimental model

“…The current study suggests that this can be achieved with the Glenn shunt, which decreased mean RA pressure (surrogate for CVP) from 20.3 to 13.4 mmHg. In addition, others have shown that a secondary effect of RV volume exclusion is a partial reversal of the left ventricular dysfunction that occurs during RV failure [18]. However, the modified Glenn shunt is only a possible solution in patients with low pulmonary vascular resistance and LV end-diastolic pressure.…”

Markedly Dilated Right Heart 17 Years After Initial Treatment Repaired by Total Right Ventricular Exclusion and Total Cavopulmonary Connection

“…1 This procedure improves the cardiac index 2 and suppresses supraventricular/ventricular tachyarrhythmia. Using this procedure with an extracardiac conduit, we successfully treated severe heart failure characterized by a markedly dilated right heart lacking tricuspid leaflets and by recurrent tachyarrhythmia, 17 years after the patient had undergone initial definitive intracardiac repair including RV outflow tract plasty.…”

“…To date, 8 cases of the total RV exclusion procedure for Ebstein's anomaly and ARVC have been reported. 1,2 We are the first group to apply this procedure to a patient with failing Fontan circulation with markedly dilated RA and RV and a history of congenitally unguarded tricuspid orifice. In this case, similar to a failing Fontan resulting from a failing atriopulmonary connection, energy losses in the circuit were increased by the dilated RA and RV, as well as by the compliance of their walls and compression of pulmonary veins.…”