Objetive: To introduce a new surgical technique for biventricular correction of the double-outlet right ventricle with non-commited ventricular septal defect. Methods: In the period from April 1987 to February 1996, 15 patients with this anomaly were operated on with a new technique for biventricular repair, using multiple patches of bovine pericardium in order to create a tunnel between the left ventricle and the aorta. Ages ranged from 2 months to 13 years (mean-age 4.8 years). Thirteen patients had situs solitus and levocardia, 1 patient situs inversus and dextrocardia, and 1 patient situs solitus and dextrocardia. Construction of the tunnel begins at the right atrium. The ventricular septal defect (VSD) is enlarged anteriorly, if restrictive or small, and the first patch is sutured in the infero-posterior edge of the VSD. The second, third and sometimes the fourth patche are sutured in sequence, through the right ventriculotomy, directing the tunnel to the aortic annulus. Results: Overall mortality was 20%, 2 early and 1 late death. The surviving patients were followed-up for a period ranging from 10 months to 9 years (mean 33 months), and all are in functional class I (NYHA). A minimal residual ventricular septal defect was diagnosed by echocardiography in 1 patient, pulmonary residual stenosis in 2 patients and moderate degree of pulmonary insufficiency in 1. There is no any degree of obstruction of the intraventricular tunnel between the LV and the aorta. Conclusion: Based on these data, we conclude that this technical modification for the biventricular repair of the double-outlet right ventricle with non-committed VSD permits the construction of the tunnel with adequate internal diameter, respecting the spatial changes existing between the VSD and aorta. Besides this, the intraventricular bovine pericardial tunnel occupies less space, reducing the incidence of the outflow right ventricle obstruction.
Double outlet righ ventricle; Heart surgery; Heart ventricle; Surgical flaps
