Overview
Double outlet left ventricle (DOLV) is a congenital heart defect where both great arteries (aorta and pulmonary artery) arise predominantly from the left ventricle, necessitating surgical intervention to establish normal blood flow pathways 1.Diagnosis
Echocardiography is essential for initial diagnosis, delineating the anatomy of the ventricles, great arteries, and ventricular septal defect (VSD) 1.
Cardiac MRI or CT angiography may be used for detailed anatomical assessment 1.
Hemodynamic evaluation through catheterization can confirm findings and guide surgical planning 1.Management
Biventricular Repair Techniques:
- For subaortic VSD with mild pulmonic valvar stenosis, translocation of the main pulmonary artery and valve to the right ventricle can be effective 1.
- In cases with mild or absent pulmonic stenosis, repair may involve right-sided conduits or intraventricular baffles, depending on VSD characteristics 1.
- Biventricular repair can also consider a right ventricle-to-aorta baffle when subaortic VSD is present 1.
Fontan-Type Procedure: Recommended for scenarios involving severe tricuspid abnormalities and right ventricular hypoplasia 1.Special Populations
Pediatrics: Specific surgical techniques tailored to age and anatomical variations are crucial for successful outcomes 1.Key Recommendations
Consider biventricular repair techniques such as translocation of the pulmonary artery and valve for subaortic VSD with mild pulmonic stenosis (Evidence: Moderate) 1.
Employ Fontan-type procedures in cases of severe tricuspid abnormalities and right ventricular hypoplasia (Evidence: Moderate) 1.
Tailor surgical approaches based on the specific anatomy of the VSD and presence of pulmonic stenosis (Evidence: Expert opinion) 1.References
1 DeLeon SY, Ow EP, Chiemmongkoltip P, Vitullo DA, Quinones JA, Fisher EA et al.. Alternatives in biventricular repair of double-outlet left ventricle. The Annals of thoracic surgery 1995. link