BACKGROUND: It has been shown that low-grade electrical stimulus can transform fatigue resistant muscles which then can be used to protect the heart. The bulky and cumbersome power sources of the artificial heart or implantable ventricular assist devices are still in need of solution; however, on the other hand, the implantable ventricular assist devices using the resistant muscles as the power source have the advantages of using its own muscle contractions. The purpose of this study was to determine the possibility of a clinical application of the skeletal muscle ventricle. MATERIAL AND METHOD: Latissimus dorsi muscles (LDM) of 8 canines were used for skeletal muscle ventricle. A latex chamber was wrapped one and a half times with LDM. The chamber was attached to a pressure transducer via Tygon tube. An electrode stimulator was placed around the thoracodorsal nerve and LDM was stimulated in cyclic bursts of 0.31 sec on time and 6.0 sec off time using 3.0 volt Itrel stimulator. The preload volume was added to the system in 25cc increments. Ejection volumes, pressures, and peak power outputs were measured. RESULT: Ejection volume was 76.3cc with 0cc of preload. Ejection volumes were less than 70ml with increments of preload over 75cc Pressures were more than 107 mmHg when the preloads were less than 75cc and less than 100 mmHg when the preloads were more than 100cc. Peak power output of 16.6 W/kg was observed at 50cc preload. CONCLUSION: Depending on the changes of preload, the volumes ejected from skeletal muscle ventricle and pressures from the skeletal muscle contraction surpassed those of the normal heart. These data suggest that there are clinical applications for skeletal muscle ventricular assist system.
Electric Power Supplies ; Electrodes ; Fatigue ; Hand ; Heart ; Heart Ventricles ; Heart, Artificial ; Heart-Assist Devices ; Latex ; Muscle Contraction ; Muscle, Skeletal* ; Muscles ; Skeletal Muscle Ventricle* ; Superficial Back Muscles ; Transducers, Pressure

Double outlet right ventricle (DORV) and transposition of the great arteries (TGA) with ventricular septal defect (VSD) and pulmonary stenosis (PS) are complex heart diseases, the treatment of which remains a surgical challenge. The Rastelli procedure is still the most commonly performed treatment. Aortic root translocation including an arterial switch operation is advantageous anatomically since it has a lower possibility of conduit blockage and the left ventricle outflow tract remains straight. This study reports successful aortic root transpositions in two patients, one with DORV with VSD and PS and one with TGA with VSD and PS. Both patients were discharged without postoperative complications.
Arterial Switch Operation ; Arteries* ; Double Outlet Right Ventricle* ; Heart Diseases ; Heart Septal Defects, Ventricular* ; Heart Ventricles ; Humans ; Postoperative Complications ; Pulmonary Valve Stenosis*

Congenital diverticula of the cardiac ventricle have been reported as arising either from the left ventricule or, rarely from both ventricules. A diverticulum arising from the right ventricle alone is very rare. Double chambered right ventricle(DCRV) was first described in 1962 by Lucas et al, and account for 1.5% of congenital heart disease. Right ventricular diverticulum are associated with right ventricle outlet obstructive disease, tetralogy of fallot, double outlet right ventricle, pulmonic stenosis, ventricular septal defect, left ventricule-right atrium communication, persistant truncus arteriosus. DCRV are freqently associated with ventricular septal defect(80%), pulmonic stenosis(33%), renal anormaly(43%). Treatment consist of suture of diverticulum and resection of septum. We report a case of double chambered right ventricle with congenital right ventricular true diverticulum in 62 years of female patients admitted due to anterior chest pain and mild exertional dyspnea.
Chest Pain ; Diverticulum* ; Double Outlet Right Ventricle ; Dyspnea ; Female ; Heart Defects, Congenital ; Heart Septal Defects, Ventricular ; Heart Ventricles* ; Humans ; Pulmonary Valve Stenosis ; Sutures ; Tetralogy of Fallot ; Truncus Arteriosus

Morphological evaluations accounting the associated anomalies were performed in the 60 cases of tricuspid atresia, diagnosed at Division of Pediatric Cardiology. The following results were obtained. 1) Twenty one out of the 6 cases had transposition of the great vessels, among which 8 cases were in complete A-transposition. 2) Seven cases were associated with pulmonany atresia, in 1 case, aorta arise from morphological right ventricle and in 6 case, aorta from morphological left ventricle. Pulmonary stenosis or pulmonary outflow obstruction was found in 52 cases except the rest 8 cases. 3) Four cases were associated with double outlet right ventricle and double outlet left ventricle in 1 case. In conclusion, for the classification of tricuspid atresia on the clinical basis, every possible interrelation of great vessels should be put into full consideration and pulmonary atresia, with very few exceptions, be separated as and isolated item due to the impracticability to verify the origin of pulmonary arteries.
Aorta ; Cardiology ; Classification* ; Double Outlet Right Ventricle ; Heart Ventricles ; Pulmonary Artery ; Pulmonary Atresia ; Pulmonary Valve Stenosis ; Tricuspid Atresia*

Double outlet right ventricle, a complex of congenital cardiac anomalies in which both great arteries arise wholly or in large part from the morphologic right ventricle presents diverse clinical manifestations according to the morphological characteristics. Eighty cases with DORV were diagnosed and operated at Yonsei Cardiovascular Center from 1988 to 1992. The analysis of the morphological characteristics of this anomaly and comparative study of operative methods and mortality according to the morphological classification led to the following results: 1) The location of VSD varied to be subaortic in 40 cases, subpulmonic in 15, doubly committed in 6 and noncommitted in 19 cases. The great arteries were interrelated in D-malposition in 43 cases and L-malposition in 18 and 26 cases among above mentioned 61 cases revealed the side-by-side relationship. Ten of the cases showed normal position and the rest 9, A-malposition. 2) Pulmonary stenosis was found in 60 cases, and when associated with subpulmonic VSD, occurring less frequently. PDA and ASD secundum were associated in successional order and only 3 cases were verified to carry aortic arch anomalies such as coarctation and interruption, all with subpulmonic VSD. 3) Intraventricular tunnel repair was possible in every case associated with subaortic VSD and the postoperative prognosis was excellent. In comparison, most of the cases associated with other types of VSD in which only palliative surgery or various types of intraventricular repair were performed, the general outcome was poor. But total cavopulmonary connection, one of the physiological corrective methods, showing a better postoperative prognosis is being carefully considered for its broad adoptation in future. In conclusion, double outlet right ventricle, a pathophysiological complex of various anomalies, should be thoroughly evaluated for the morphological characteristics to decide the most appropriate types of operation and for consequent improvement of prognosis.
Aorta, Thoracic ; Arteries ; Classification ; Double Outlet Right Ventricle* ; Heart Ventricles ; Mortality ; Palliative Care ; Prognosis ; Pulmonary Valve Stenosis

BACKGROUND: This study is to evaluate the effectiveness and application of Lecompte procedure as a treatment for various complex cardiac anomalies with pulmonary outflow tract obstruction. Methods: Between July 1988 and December 1997, 44 patients underwent Lecompte procedure in Seoul National University Children's Hospital. The male to female ratio was 24 to 20 and the mean age was 29.2 months (range, 3 to 83). Of these patients, 28 (63.6%) had transposition of great arteries with ventricular septal defect and pulmonary stenosis (or pulmonary atresia), 14 (31.8%) had double outlet right ventricle with pulmonary stenosis (or pulmonary atresia), and so on. The principles of the technique are 1) extension of the ventricular septal defect or conal resection, 2) construction of a intracardiac tunnel connecting the left ventricle to the aorta, and 3) direct connection, without a prosthetic conduit, of the pulmonary trunk to the right ventricle. RESULTS: There were 3 in-hospital deaths and their causes were sustained hypoxia, myocardial failure, and sepsis, respectively. There was 1 late death due to sepsis. Reoperations were performed in 6 patients who had pulmonary outflow tract obstructions (4 cases), residual muscular ventricular septal defect (1 case), and recurrent septic vegetation (1 case). The cumulative survival rates by the Kaplan-Meier method were 92.7%, 92.7%, and 92.7% at 1, 2, and over 4 years. The reoperation free survival rates were 92.7%, 92.7%, and 70.2% at 1, 3, and over 5 years. Among the risk factors for the operative death, aortic cross clamping time had statistical significance (p<0.05) and all the risk factors for the recurrent pulmonary stenosis such as age, pulmonary artery index, and materials used for the pulmonary outflow tract reconstruction had no statistical significance (p>0.05). CONCLUSIONS: Our review suggests that Lecompte procedure is an effective treatment modality for various complex cardiac anomalies with pulmonary outflow tract obstruction. Repair in early age is possible and the rates of mortality and morbidity are also acceptable.
Anoxia ; Aorta ; Constriction ; Double Outlet Right Ventricle ; Female ; Heart Diseases* ; Heart Failure ; Heart Septal Defects, Ventricular ; Heart Ventricles ; Heart* ; Humans ; Male ; Mortality ; Pulmonary Artery ; Pulmonary Valve Stenosis ; Reoperation ; Risk Factors ; Seoul ; Sepsis ; Survival Rate ; Transposition of Great Vessels

Congenital right ventricular diverticulum is extremely rare and is associated with other congenital cardiac anomalies. It functionally behaves like an accessory ventricular chamber which contracts synchronously with the normal ventricles. Only dozens of patients with right ventricular diverticulum have been reported in literature worldwide and one case in Korea. An apical right ventricular diverticulum occurs in patients with thoracoabdominal midline defects or abnormalities of the cardiac position. However, an antero-superior diverticulum is usually associated with other congenital cardiac defects, such as a ventricular septal defect, tetralogy of Fallot, double outlet right ventricle, and pulmonary stenosis. We report a 69-year-old woman with a congenital right ventricular diverticulum without associated cardiac anomalies. The right ventricular diverticulum was diagnosed by echocardiography, right ventriculography, and cardiac MRI.
Adult* ; Aged ; Diverticulum* ; Double Outlet Right Ventricle ; Echocardiography ; Female ; Heart Septal Defects, Ventricular ; Heart Ventricles ; Humans ; Korea ; Magnetic Resonance Imaging ; Pulmonary Valve Stenosis ; Tetralogy of Fallot

Background: The Lecompte procedure for transposition of the great arteries has an advantage because it obviates the need for an extracardiac conduit for the reconstruction of the pulmonary outflow tract. We evaluated the effectiveness and the application of the Lecompte procedure. Material and Method: A retrospective review was conducted of the records of 46 patients who underwent the Lecompte procedure during the past 15 years. Mean age at operation was 29.2+/-20.3 (range: 3~83) months. The diagnoses involved anomalies of the ventriculoarterial connection with ventricular septal defect and pulmonary outflow tract obstruction, such as transposition of the great arteries, double-outlet right ventricle, and double-outlet left ventricle. Result: Early mortality was 4.4% (2 of 46 patients) and late mortality was 6.8% (3 of 44). The mean follow-up was 11.2+/-6.9 years. Eighteen patients (43.9% of survivors, n=41) had pulmonary stenosis (pressure gradient above 30 mmHg), the main reason for which was a calcified monocusp valve (n=15, 83.3%). Seventeen of 46 patients (37.0%) underwent reoperation: 15 for pulmonary stenosis, 5 for residual ventricular septal defect, 4 for left ventricular outflow tract obstruction, 3 for pulmonary insufficiency, and 4 for other causes. The cumulative survival rates were 91.3+/-4.2%, and 87.0+/-5.8% at 10 and 15 years, respectively. The actuarial probabilities of freedom from reoperation for pulmonary stenosis were 90.6+/-4.5%, 73.9+/-7.3%, and 54.0+/-10.4% at 5, 10, and 15 years, respectively. Conclusion: The Lecompte procedure is an effective treatment modality. Repair in early age is possible with acceptable morbidity and mortality, but recurrent right ventricular outflow tract obstruction caused by degeneration of the monocusp valve is a problem that needs resolution.
Arteries ; Diagnosis ; Double Outlet Right Ventricle ; Follow-Up Studies ; Freedom ; Heart Defects, Congenital ; Heart Septal Defects, Ventricular ; Heart Ventricles ; Humans ; Mortality ; Pulmonary Valve Stenosis ; Reoperation ; Retrospective Studies ; Survival Rate ; Survivors ; Transposition of Great Vessels

Criss-cross heart which is a cardiac malformation caused by abnormal rotation of the ventricles early in embryonic development, is rare but a double outlet of right ventricle in criss-cross heart is very rare. We experienced a case of criss-cross heart which is situs solitus, concordant atrioventricular connection and double outlet of right ventricle with remote ventricular septal defect of perimembranous inlet type. A 4-years old female was diagnosed as a double outlet of right ventricle in criss-cross heart after echocardiography, cardiac catheterization and cardiac angiography. The surgical correction was a intraventricular reconstruction of left ventricular outflow with 3/4 circle of 20 mm Hemashield vascular graft from the ventricular septal defect to the aorta. The patient had a temporary atrioventricular block but was recovered uneventfully, and a postoperative echocardiogram showed no left ventricular outflow obstruction, no intracardiac shunt.
Angiography ; Aorta ; Atrioventricular Block ; Bays ; Cardiac Catheterization ; Cardiac Catheters ; Child, Preschool ; Crisscross Heart* ; Double Outlet Right Ventricle ; Echocardiography ; Embryonic Development ; Female ; Heart Septal Defects, Ventricular ; Heart Ventricles* ; Humans ; Pregnancy ; Transplants ; Ventricular Outflow Obstruction

BACKGROUND: We reviewed our 18-year surgical experience of biventricular repair for double-outlet right ventricle. MATERIAL AND METHOD: One hundred twelve consecutive patients (80 males and 32 females) who underwent biventricular repair for double-outlet right ventricle between May 1986 and September 2002 were included. We assessed risk factors for early mortality and reoperation. Reoperation-free survival rate and actual survival rate were analysed. RESULT: Most common type of ventricular septal defect was subaortic (n=58, 52%) and non-committed type was second most common (n=32, 29%). Four different surgical methods were used: intraventricular baffle repair (n=71, 63%); right ventricle to pulmonary artery conduit interposition or REV with left ventricle to aorta baffle repair (n=24, 21.4%); arterial switch operation with left ventricle to pulmonary artery baffle (n=14, 12.5%); Senning atrial switch operation with left ventricle to pulmonary artery baffle (n=3, 2.7%). Thirty four patients(30%) underwent palliative procedures before definite repair. Twenty three patients (21%) required reoperations. There were 12 (10.7%) early deaths and 4 late deaths. Age younger than 3 months at repair (p=0.003), cardiopulmonary bypass and aortic cross clamp time (p=0.015, p=0.067), type of operation (arterial switch operation) (p<0.001) and type of ventricular septal defect (subpulmonic type) (p=0.002) were revealed as risk factors for early death in univariate analysis, while age under 3 months was the only significant risk factor in multivariate analysis. Patients younger than 1 year of age (p=0.02), pulmonary artery angioplasty at definitive repair (p=0.024), type of ventricular septal defect (non-committed) (p=0.001), type of operation (right ventricle to pulmonary artery conduit interposition and REV operation) (p=0.028, p=0.017) were risk factors for reoperation in univariate analysis but there was no significant risk factor in multivariate analysis. Follow-up was available on 91 survivals with a mean duration of 110.8+/-56.4 (2~201) months. 5, 10 and 15 year survival rates were 86.5%, 85% and 85% and reoperation free survival were 85%, 71.5%, 70%. CONCLUSION: Age under 3 months at repair, subpulmonic ventricular septal defect and arterial switch operation were significant risk factors for early mortality. Patients with non-committed ventricular septal defect and who underwent conduit interposition or REV operation were risk factors for reoperation. With careful attention to chose best timing and surgical approach depending on morphologic characteristics, biventricular repair for double outlet right ventricle can be achieved with good long-term outcome.
Angioplasty ; Aorta ; Cardiopulmonary Bypass ; Double Outlet Right Ventricle* ; Follow-Up Studies ; Heart Defects, Congenital ; Heart Septal Defects, Ventricular ; Heart Ventricles ; Humans ; Male ; Mortality ; Multivariate Analysis ; Pulmonary Artery ; Reoperation ; Risk Factors ; Survival Rate