Biventricular repair of cardiac isomerism with common atrioventricular canal with the aid of an endocardial cushion prosthesis

Abstract

Between 1983 and 1990, six patients with atrial isomerism associated with common atrioventricular canal and double-outlet right ventricle were operated on with the aid of an endocardial cushion prosthesis. This prosthesis, which has been used for the repair of common atrioventricular canal since 1975, is composed of a vertical Dacron patch and "wings" constructed from the patient's own pericardium, which are attached to both sides of the patch to compensate for the defective atrioventricular valve tissue. The ventricular portion of the patch was extended anteriorly to construct the route for blood flow from the left ventricle to the aorta. Intraventricular repair was performed through the common atrioventricular orifice in all patients and also through an additional right ventriculotomy in one patient. The complex systemic and pulmonary venous return was separated by use of the atrial part of the endocardial cushion prosthesis together with additional prosthetic materials. All patients survived the operation and were followed up from 1 to 9 years. All of them are doing well, although one patient has a significant interventricular residual shunt. Repair of atrial isomerism with common atrioventricular canal and double-outlet right ventricle with an endocardial cushion prosthesis was performed with satisfactory immediate and intermediate-term postoperative results.