In our practice, we no longer use the terms of double-outlet right ventricle, Taussig-Bing anomaly, double outlet left ventricle, or transposition of the great arteries when associated with a ventricular septal defect. We call anomalous ventriculo-arterial connection any connection different from that of a normal heart. In these anomalies the aim of the repair is to connect theleft ventricle to the aorta and the right ventricle to the pulmonary trunk. The strategy we have chosen, for empirical reasons, is based on the hypothesis that the simplest methods which require no prosthetic conduit, no translocation of the coronary arteries and no complex partition of the ventricular cavity offer the best chances of optimal long term results. The feasibility of anatomic repair was investigated in 197 patients who underwent an operation for anomalies of ventriculo-arterial connection associated with ventricular septal defect. Three types of anatomic repair were used: intraventricular rerouting (35 patients), R.E.V. (association of intraventricular rerouting with translocation of the pulmonary arterial trunk on the right ventricle) in 78 patients, and Jatene's operation with closure of the ventricular septal defect (49 patients). Our repair of choice is intraventriclar repair when it is possible to construct a straight and direct tunnel from the left ventricle to the aorta. Thus, the basic question is the feasibility of a simple intraventricular repair. We presently base our strategy in all types of anomalous ventriculo-arterial connection on the preoperative measurement of the minimal distance between the tricuspid valve and the pulmonary valve. Either this distance is significant (at least equal to the diameter of the aortic orifice) and the intraventricular repair is feasible, or it is shorter and another type of repair is indicated. We then perform a R.E.V. in cases associated with pulmonary stenosis or Jatene's operation in cases with increased pulmonary blood flow. Our present experience suggests that the measurement of intervalvar distances is, from a surgical standpoint, the most important information adequately to choose the of repair for the anomalies of ventriculoatrial connection. This approach is not in contrast with the usual classifications based on the position of the great arteries and/or the situation of the ventricular septal defects. It gives information which is directly related to the feasibility of intraventricular repair.
ventriculo-arterial connection