SINGLE%20VENTRICLES

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SINGLE VENTRICLES

• Perils
• of
• Imperfect
• Plumbing

R. Dennis Steed, MD Associate Professor Department
of Pediatrics Division of Pediatric
Cardiology East Carolina University Brody
School of Medicine Greenville, NC
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Single VentriclesAnatomical Substrates

• Atresia / hypoplasia of valves
• Double inlet ventricles
• Severely unbalanced AV canal defects with complex
  attachments
• Atrial isomerism / heterotaxy

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TRICUSPID ATRESIA
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Single VentriclesNorwood Procedure

• Neonatal open procedure
• First week of life
• Reconstruction of aorta using pulmonary artery
  and placement of BT shunt

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Stage I Norwood with Sano Modification

• Sano Modification

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Single VentriclesGlenn Shunt / Hemi - Fontan

• 6 - 9 months
• volume unloads ventricle
• addresses any pulmonary artery distortion
• perceived decrease in pleural effusions
• facilitates completion of Fontan

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Single VentriclesFontan Procedure

• Generally done at 2 - 4 years of age
• Intra-atrial baffle of inferior vena caval blood
  to pulmonary artery
• Common to use fenestration
• Extracardiac conduit of inferior caval blood to
  pulmonary artery

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Single VentriclesFontan Procedure
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Key Components of Favorable Post-Fontan
Hemodynamics 1.Normal ventricular function
(systolic and diastolic) 2.Lack of important A-V
valve incompetence. 3.Low trans-pulmonary
gradient.
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Evaluation of Systolic Ventricular function in
Univentricular Hearts Use a method that is
reproducible to allow for serial comparisons
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Evaluation of Systolic Ventricular function in
Univentricular Hearts Left ventricular
morphology routine ejection indices for your
lab. Right ventricular morphology Mid cavitary
two-dimensional area shortening may be most
reliable.
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• Evaluation of Diastolic Ventricular function in
  Univentricular Hearts
• EA ratios.
• May use IVRT with ventricles of left ventricular
  morphology (sufficient proximity between the
  aortic valve and a A-V valve.

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• Trans-pulmonary Gradient
• Ideal 3- 5 mm Hg
• Satisfactory 6-8 mm Hg