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Lioncino M, Calcagni G, Badolato F, Antonelli G, Leonardi B, de Zorzi A, Secinaro A, Brancaccio G, Albanese S, Carotti A, Drago F, Rinelli G. Double-Outlet Left Ventricle: Case Series and Systematic Review of the Literature. Diagnostics (Basel) 2023; 13:3175. [PMID: 37891996 PMCID: PMC10605834 DOI: 10.3390/diagnostics13203175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 09/24/2023] [Accepted: 10/03/2023] [Indexed: 10/29/2023] Open
Abstract
Double-outlet left ventricle (DOLV) is an abnormal ventriculo-arterial connection characterized by the origin of both great arteries from the morphological left ventricle. The aim of our paper is to describe the morphological and imaging features of DOLV and to assess the prevalence of the associated malformations and their surgical outcomes. METHODS From 2011 to 2022, we retrospectively reviewed the electronic case records of patients diagnosed with DOLV at the Bambino Gesu Children's Hospital. A systematic search was developed in MEDLINE, Web of Science, and EMBASE databases to identify reports assessing the morphology and outcomes of DOLV between 1975 and 2023. RESULTS: Over a median follow-up of 9.9 years (IQR 7.8-11.7 y), four cases of DOLV were identified at our institution. Two patients were diagnosed with (S,D,D) DOLV subaortic VSD and pulmonary stenosis (PS): one patient had (S,D,D) DOLV with doubly committed VSD and hypoplastic right ventricle, and another patient had (S,D,L) DOLV with subaortic VSD and PS (malposition type). Pulmonary stenosis was the most commonly associated lesion (75%). LITERATURE REVIEW: After systematic evaluation, a total of 12 reports fulfilled the eligibility criteria and were included in our analysis. PS or right ventricular outflow tract obstruction was the most commonly associated lesion (69%, 95% CI 62-76%). The most common locations of VSD were subaortic (pooled prevalence: 75%, 95% CI 68-81), subpulmonary (15%, 95% CI 10-21), and doubly committed (7%, 95% CI 4-12). The position of the great arteries showed that d-transposition of the aorta was present in 128 cases (59% 95% CI 42-74), and l-transposition was present in 77 cases (35%, 95% CI 29-43).
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Affiliation(s)
- Michele Lioncino
- Pediatric Cardiology and Cardiac Arrhythmias and Syncope Unit, Bambino Gesù Children’s Hospital, IRCSS, 00146 Rome, Italy; (G.C.); (G.A.); (B.L.); (A.d.Z.); (F.D.); (G.R.)
| | - Giulio Calcagni
- Pediatric Cardiology and Cardiac Arrhythmias and Syncope Unit, Bambino Gesù Children’s Hospital, IRCSS, 00146 Rome, Italy; (G.C.); (G.A.); (B.L.); (A.d.Z.); (F.D.); (G.R.)
| | - Fausto Badolato
- Pediatric Cardiology and Cardiac Arrhythmias and Syncope Unit, Bambino Gesù Children’s Hospital, IRCSS, 00146 Rome, Italy; (G.C.); (G.A.); (B.L.); (A.d.Z.); (F.D.); (G.R.)
| | - Giovanni Antonelli
- Pediatric Cardiology and Cardiac Arrhythmias and Syncope Unit, Bambino Gesù Children’s Hospital, IRCSS, 00146 Rome, Italy; (G.C.); (G.A.); (B.L.); (A.d.Z.); (F.D.); (G.R.)
| | - Benedetta Leonardi
- Pediatric Cardiology and Cardiac Arrhythmias and Syncope Unit, Bambino Gesù Children’s Hospital, IRCSS, 00146 Rome, Italy; (G.C.); (G.A.); (B.L.); (A.d.Z.); (F.D.); (G.R.)
| | - Andrea de Zorzi
- Pediatric Cardiology and Cardiac Arrhythmias and Syncope Unit, Bambino Gesù Children’s Hospital, IRCSS, 00146 Rome, Italy; (G.C.); (G.A.); (B.L.); (A.d.Z.); (F.D.); (G.R.)
| | - Aurelio Secinaro
- Advanced Cardiothoracic Imaging Unit, Bambino Gesù Children’s Hospital, IRCSS, 00165 Rome, Italy;
| | - Gianluca Brancaccio
- Cardiac Surgery Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (G.B.); (S.A.); (A.C.)
| | - Sonia Albanese
- Cardiac Surgery Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (G.B.); (S.A.); (A.C.)
| | - Adriano Carotti
- Cardiac Surgery Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (G.B.); (S.A.); (A.C.)
| | - Fabrizio Drago
- Pediatric Cardiology and Cardiac Arrhythmias and Syncope Unit, Bambino Gesù Children’s Hospital, IRCSS, 00146 Rome, Italy; (G.C.); (G.A.); (B.L.); (A.d.Z.); (F.D.); (G.R.)
| | - Gabriele Rinelli
- Pediatric Cardiology and Cardiac Arrhythmias and Syncope Unit, Bambino Gesù Children’s Hospital, IRCSS, 00146 Rome, Italy; (G.C.); (G.A.); (B.L.); (A.d.Z.); (F.D.); (G.R.)
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Arora Y, Devagourou V, Adarsh P, Kar T. Pulmonary root translocation in corrected transposition of great arteries with ventricular septal defect and pulmonary stenosis with dextrocardia. J Card Surg 2020; 36:748-751. [PMID: 33331022 DOI: 10.1111/jocs.15260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 11/30/2022]
Abstract
We present 13 years old with history of cyanosis and diagnosis of congenitally corrected transposition of great arteries with ventricle septal defect and pulmonary stenosis with dextrocardia. He underwent modified Senning procedure with pulmonary root translocation. Postoperative recovery was uneventful and was extubated on postoperative day 1. Patient remained in sinus rhythm. Postoperative echocardiography showed good biventricular function with no baffle obstruction and mild pulmonary regurgitation with no significant left and right outflow tract obstruction. Patient was discharged on postoperative day 6 and remained asymptomatic on follow up at 3 months.
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Affiliation(s)
- Yatin Arora
- Department of Cardiovascular and Thoracic Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Velayoudam Devagourou
- Department of Cardiovascular and Thoracic Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Paidi Adarsh
- Department of Cardiovascular and Thoracic Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Tanushree Kar
- Department of Cardiovascular and Thoracic Surgery, All India Institute of Medical Sciences, New Delhi, India
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Raja J, Menon S, Ramanan S, Dutta Baruah S, Devarakonda BV, Gopalakrishnan A, Dharan BS. Bi‐ventricular repair of double outlet left ventricle: Experience and review of the literature. J Card Surg 2020; 35:1865-1870. [DOI: 10.1111/jocs.14768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 05/28/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Javid Raja
- Department of Cardiothoracic and Vascular Surgery Sree Chitra Tirunal Institute for Medical Sciences & Technology Trivandrum Kerala India
| | - Sabarinath Menon
- Department of Cardiothoracic and Vascular Surgery Sree Chitra Tirunal Institute for Medical Sciences & Technology Trivandrum Kerala India
| | - Sowmya Ramanan
- Department of Cardiothoracic and Vascular Surgery Sree Chitra Tirunal Institute for Medical Sciences & Technology Trivandrum Kerala India
| | - Sudip Dutta Baruah
- Department of Cardiothoracic and Vascular Surgery Sree Chitra Tirunal Institute for Medical Sciences & Technology Trivandrum Kerala India
| | - Bhargava V. Devarakonda
- Department of Cardiothoracic and Vascular Surgery Sree Chitra Tirunal Institute for Medical Sciences & Technology Trivandrum Kerala India
- Department of Cardiac Anaesthesia Sree Chitra Tirunal Institute for Medical Sciences & Technology Trivandrum Kerala India
| | - Arun Gopalakrishnan
- Department of Cardiothoracic and Vascular Surgery Sree Chitra Tirunal Institute for Medical Sciences & Technology Trivandrum Kerala India
- Department of Cardiology Sree Chitra Tirunal Institute for Medical Sciences & Technology Trivandrum Kerala India
| | - Baiju S. Dharan
- Department of Cardiothoracic and Vascular Surgery Sree Chitra Tirunal Institute for Medical Sciences & Technology Trivandrum Kerala India
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Luciani GB, De Rita F, Lucchese G, Barozzi L, Rossetti L, Faggian G, Mazzucco A. Current management of double-outlet left ventricle. J Cardiovasc Med (Hagerstown) 2017; 18:311-317. [DOI: 10.2459/jcm.0000000000000101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Truong NLT, Tiep DH, Ha NTT, Dien TM, Hoa PH, Liem NT. Modified Lecompte procedure for repair of double-outlet left ventricle. Asian Cardiovasc Thorac Ann 2012; 20:578-80. [PMID: 23087304 DOI: 10.1177/0218492312437384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A modification of the Lecompte procedure was used successfully for total correction in 2 boys aged 3 and 6 months with double-outlet left ventricle. The operative procedure and short-term results are evaluated.
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Jhang WK, Park JJ, Seo DM, Goo HW, Gwak M. Perioperative evaluation of airways in patients with arch obstruction and intracardiac defects. Ann Thorac Surg 2008; 85:1753-8. [PMID: 18442579 DOI: 10.1016/j.athoracsur.2008.01.059] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2007] [Revised: 01/17/2008] [Accepted: 01/18/2008] [Indexed: 10/22/2022]
Abstract
BACKGROUND Patients with arch obstruction and intracardiac defects have a high probability of abnormal aortopulmonary space geometry, which provides airway compression. The tissue-to-tissue technique arch repair could result in real airway problems. This report describes our experience with the perioperative evaluation and management of airway problems. METHODS We retrospectively reviewed the medical records of 90 patients with arch obstruction and intracardiac defects who underwent computed tomography (CT) and corrective surgery in our institution between January 2000 and January 2007. RESULTS Of the 77 patients who underwent preoperative CT (group 1), 21 were found to have airway compression (27.2%). Of those 21 patients, 5 underwent concomitant airway relieving procedures. In group 1, 2 patients required subsequent secondary surgery for airway problems after the initial arch repair. Of the 13 patients who underwent postoperative CT only (group 2), 6 underwent subsequent secondary surgery for airway relief. For airway relief, several procedures were additionally performed (eg, right pulmonary artery translocation anterior to the aorta, aortopexy, peribronchial dissection, and tissue augmentation). In terms of the type of arch repair, 48 patients underwent end-to-side anastomosis, 39 underwent extended end-to-end anastomosis, and 3 underwent end-to-end anastomosis. End-to-side was the repair type most commonly associated with airway compression requiring additional procedure (10 of 15, 66.6%). CONCLUSIONS Patients with arch obstruction and intracardiac defects had a rather high incidence of airway compression preoperatively and postoperatively. Preoperative CT and intraoperative complementary bronchoscopy were useful for identifying and fixing the airway problems. Additional procedures for relieving airway compression were required more frequently after end-to-side type arch repair than after extended end-to-end anastomosis. More meticulous intraoperative evaluation and management are recommended in this type of repair.
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Affiliation(s)
- Won Kyoung Jhang
- Division of Pediatric Cardiac Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
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