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SINGLE VENTRICLES

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. Single Ventricles Anatomical Substrates.

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SINGLE VENTRICLES

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  1. 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

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

  3. TRICUSPID ATRESIA 1.5 : 1

  4. Single VentriclesNorwood Procedure • Neonatal open procedure • First week of life • Reconstruction of aorta using pulmonary artery and placement of BT shunt

  5. Stage I Norwood with Sano Modification: • Sano Modification

  6. 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

  7. 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

  8. Single VentriclesFontan Procedure

  9. 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.

  10. Evaluation of Systolic Ventricular function in Univentricular Hearts: Use a method that is reproducible to allow for serial comparisons

  11. 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.

  12. Evaluation of Diastolic Ventricular function in Univentricular Hearts: E:A ratios. May use IVRT with ventricles of left ventricular morphology (sufficient proximity between the aortic valve and a A-V valve.

  13. Trans-pulmonary Gradient: Ideal: 3- 5 mm Hg Satisfactory: 6-8 mm Hg

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