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(Circulation. 2003;108:II-226.)
© 2003 American Heart Association, Inc.

Cardiac Transplantation and Surgery for Congestive Heart Failure

Total Right Ventricular Exclusion Improves Left Ventricular Function in Patients With End-Stage Congestive Right Ventricular Failure

Masami Takagaki, MD, PhD; Kozo Ishino, MD, PhD; Masaaki Kawada, MD; Shin-ichi Ohtsuki, MD; Masanori Hirota, MD; Takeo Tedoriya, MD, PhD; Yasuharu Tanabe, BA; Mikizo Nakai, MD, PhD; Shunji Sano, MD, PhD

From the Departments of Cardiovascular Surgery, Pediatrics, and Central Clinical Laboratory; Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan.

Correspondence to Shunji Sano, MD, PhD, Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine and Dentistry, 2-5-1 Shikata-cho, Okayama, Okayama, 700-8558, Japan. Phone: 81-86-235-7357, Fax: 81-86-235-7431, E-mail: s_sano{at}cc.okayama-u.ac.jp

Background— We developed a total right ventricular (RV) exclusion procedure for the treatment of isolated congestive RV failure. The objective of the present study was to elucidate the effects of a complete removal of RV volume overload (RVVO) on the surgically created single left ventricle (LV).

Methods and Results— Three adults (2 arrhythmogenic RV dysplasia, 1 Ebstein) and 5 children (all Ebstein) in NYHA class IV underwent the procedure. The RV free wall was resected from the heart, and the tricuspid orifice was closed. Pulmonary blood supply was obtained by a cavopulmonary connection in 6 patients and a systemic-pulmonary shunt in 2. The LV function was evaluated by 2-dimensional echocardiography 1 month after the surgery. All patients are alive. The paradoxical movement of the interventricular septum and geometry of the LV expressed by its eccentricity (2.1 to 1.2, P<0.01) were normalized after the operation in all 8 patients. LV end-diastolic volumes (59% to 109% of normal value, P<0.01), indexed maximal left atrial area (6.5 to 10.5 cm²/m², P<0.01), LV ejection fraction (27% to 62%, P<0.01), and cardiac index (2.1 to 3.3 L/min/m², P<0.05) all significantly increased.

Conclusion— Removal of the RVVO by means of the total RV exclusion procedure provides effective volume loading, restores a cylindrical shape, and improves contractile function of the LV, thus leading to increased systemic output.

Key Words: heart failure • ventricular function • echocardiography • cardiac volume

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