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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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Subramaniam GK, Gnanasekaran P, Sharma D, Kumar R, Chandrashekhar A. Arterial switch for double-outlet left ventricle - Diagnostic and surgical considerations. Ann Pediatr Cardiol 2022; 15:404-408. [PMID: 36935830 PMCID: PMC10015405 DOI: 10.4103/apc.apc_150_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/12/2021] [Accepted: 06/14/2022] [Indexed: 01/07/2023] Open
Abstract
Double-outlet left ventricle (DOLV) is a rare congenital cardiac anomaly in which both the aorta and pulmonary artery arise completely or predominantly from the left ventricle. DOLV is a spectrum and can be classified depending on the position of the ventricular septal defect (VSD) relative to the great vessels, the relationship of the great vessels, and the presence or absence of pulmonary or aortic outflow obstruction. In the absence of tricuspid atresia or hypoplastic right ventricle, two ventricle repair is the preferred surgical treatment. We report a 31-day-old, 2.1 kg neonate with DOLV, subaortic VSD who underwent a successful arterial switch with VSD closure.
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Affiliation(s)
| | - Pradeep Gnanasekaran
- Department of Heart and Lung Transplant and Mechanical Circulatory Support, MGM Healthcare, Chennai, Tamil Nadu, India
| | - Dhruva Sharma
- Department of Cardiothoracic and Vascular Surgery, SMS Medical College and attached Hospitals, Jaipur, Rajasthan, India
| | - Rajesh Kumar
- Department of Paediatric Cardiology, MGM Healthcare, Aminjikarai, Chennai, Tamil Nadu, India
| | - Anitha Chandrashekhar
- Department of Heart and Lung Transplant and Mechanical Circulatory Support, MGM Healthcare, Chennai, Tamil Nadu, 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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Sohn S, Kim HS, Han JJ. Right ventricular outflow patch reconstruction for repair of double-outlet left ventricle. Pediatr Cardiol 2008; 29:452-4. [PMID: 17687588 DOI: 10.1007/s00246-007-9019-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2007] [Accepted: 06/13/2007] [Indexed: 10/23/2022]
Abstract
Double-outlet left ventricle (DOLV) is conventionally repaired with an extracardiac conduit when pulmonary stenosis is present. We report a case of surgical repair for DOLV with severe pulmonary stenosis where the right ventricular outflow tract was established using a vascular graft patch anteriorly after constructing the posterior wall with autologous tissue. This approach provides excellent hemodynamic repair without the use of an extracardiac conduit and has the major advantage of growth potential.
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Affiliation(s)
- S Sohn
- Department of Pediatrics, School of Medicine, Ewha Womans University, Seoul, 158-710, Korea.
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Lim HG, Lee JR, Bae EJ, Ahn C. Pulmonary root translocation for repair of Taussig-Bing anomaly with interrupted arch. Ann Thorac Surg 2005; 80:1943-5. [PMID: 16242499 DOI: 10.1016/j.athoracsur.2004.05.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2004] [Revised: 05/18/2004] [Accepted: 05/19/2004] [Indexed: 10/25/2022]
Abstract
Anterior translocation of the pulmonary root was used as a new approach to the staged repair of Taussig-Bing anomaly with an interrupted aortic arch. It was performed to construct the right ventricle outflow tract with intraventricular baffling of the left ventricle to the aorta as the second stage operation after repair of the interrupted arch and pulmonary artery banding. This technique allows minimization of pulmonary regurgitation and has the major theoretical advantage for growth potential, which could diminish the need for reoperation.
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Affiliation(s)
- Hong Gook Lim
- Department of Thoracic and Cardiovascular Surgery, Children's Hospital, College of Medicine, Seoul National University Hospital Clinical Research Center, Seoul, South Korea
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Ootaki Y, Yamaguchi M, Oshima Y, Yoshimura N, Oka S. Pulmonary root translocation for biventricular repair of double-outlet left ventricle. Ann Thorac Surg 2001; 71:1347-9. [PMID: 11308189 DOI: 10.1016/s0003-4975(00)02541-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Double-outlet left ventricle is conventionally repaired with an extracardiac conduit when pulmonary stenosis is present. We report the use of pulmonary root translocation to the right ventricle to construct the posterior wall with autologous tissue and a porcine pericardial monocusp ventricular outflow patch anteriorly for 2 patients with double-outlet left ventricle. This technique allows minimization of pulmonary insufficiency, avoids coronary artery ligation with infundibulotomy, and has a major theoretical advantage for growth potential.
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Affiliation(s)
- Y Ootaki
- Department of Cardiothoracic Surgery, Kobe Children's Hospital, Hyogo, Japan.
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Tchervenkov CI, Walters HL, Chu VF. Congenital Heart Surgery Nomenclature and Database Project: double outlet left ventricle. Ann Thorac Surg 2000; 69:S264-9. [PMID: 10798434 DOI: 10.1016/s0003-4975(99)01281-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Double outlet left ventricle (DOLV) is a type of ventriculoarterial connection in which both great arteries arise entirely or predominantly from the left ventricle. Although it was initially believed that bilateral absence of conus is a prerequisite for such diagnosis, all possible conal configurations have been described in this malformation. The morphology of DOLV is encompassed by a careful description of the ventricular septal defect (VSD) with its relationship to the semilunar valves, the presence or absence of pulmonary outflow tract obstruction (POTO) and aortic outflow tract obstruction (AOTO), and the presence or absence of associated cardiac lesions. The preferred surgical treatment involves the connection of the right ventricle to the pulmonary circulation by an intraventricular tunnel repair connecting the VSD to the pulmonary semilunar valve. This ideal surgical therapy is not always possible, because of the presence of confounding anatomical barriers. Several alternative surgical procedures have been devised to accommodate these more complex situations. A framework for the development of the DOLV module of a pediatric cardiac surgical database is proposed.
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Affiliation(s)
- C I Tchervenkov
- Division of Cardiovascular Surgery, The Montreal Children's Hospital, Québec, Canada
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Abstract
Anterior pulmonary root translocation is used as a new approach for anatomic repair of transposition complexes with ventricular septal defect and pulmonary stenosis. It is performed to construct the right ventricle outflow tract, after patch diversion of left ventricle to aorta. Since 1994, 3 infants underwent this procedure. The preliminary results indicate some growth of the pulmonary root and suggest that this technique could diminish reoperations in this group of patients.
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Affiliation(s)
- J P da Silva
- Division of Cardiovascular Surgery, Hospital Beneficência Portuguêsa de São Paulo, Brazil.
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