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The Systemic Right Ventricle in Biventricular and Univentricular Circulation

  • Heiner Latus
  • Christian Apitz
  • Dietmar SchranzEmail author
Chapter
Part of the Respiratory Medicine book series (RM)

Abstract

In this chapter we describe the role of the systemic right ventricle in a biventricular circulation and the univentricular heart. The ventriculo-ventricular interaction of the subaortic right ventricle is discussed in the context of (1) congenitally corrected transposition and (2) the systemic ventricle after atrial switch operation; the right ventricle as a univentricular heart based on the experiences of a hypoplastic left heart syndrome. Novel therapeutical strategies are presented in the form of pulmonary artery banding for the failing systemic right ventricle and for the retraining of the subpulmonary left ventricle; in addition, some pharmacological treatment aspects for the failing right ventricle are addressed as well as the strategy of a so-called hybrid approach which combines bilateral pulmonary banding, duct stenting, and atrioseptostomy. Importantly we highlight, what we need to learn in order to expand the therapeutic options for the majority of patients with normal anatomy but a failing subpulmonary ventricle.

Keywords

Right Ventricle Tricuspid Valve Ventricular Septal Defect Hypoplastic Left Heart Syndrome Pulmonary Artery Banding 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Supplementary material

Video 6.1

MRI shows a double outlet right ventricle with transposition of the great arteries and subpulmonary obstruction (MOV 296 kb)

Video 6.2a

Shows in MRI four-chamber view ccTGA with atrio (LA, RA) to ventricular (RV, LV) discordance, respectively. Dominant is the dilated left atrium and systemic right ventricle associated with tricuspid (systemic atrioventricular valve) regurgitation, the interatrial septum is bulging to the right. (AVI 1380 kb)

Video 6.2b, c

Lateral view at the LA-RV-AO before and after pulmonary banding combined with tricuspid valve reconstruction; the surgical strategy improved the function of the systemic RV and reduced significantly the LA enlargement and consecutively the patient’s functional status. (AVI 1402 kb)

(AVI 356 kb)

Video 6.3

Shown is echocardiographic four-chamber view of an infant with hypoplastic left heart syndrome consisting of mitral valve stenosis and aortic valve atresia. The functional single right ventricle has a sufficient systolic function. At the atrial level systemic and pulmonary vein mixed to one inflow through the tricuspid valve in the volume dilated RV. Stenting of the atrial septum became necessary for unloading the left atrium (AVI 10051 kb)

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Heiner Latus
    • 1
  • Christian Apitz
    • 1
  • Dietmar Schranz
    • 1
    Email author
  1. 1.Department of Pediatric CardiologyJustus-Liebig-UniversityGiessenGermany

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