DK2985_C000 1..28 - AlSharqia Echo Club

Congenital Heart Disease 551(A)(B)LARAV(C)(D)VFigure 24.33 Double inlet left ventricle in a 38-year-old woman who previously underwent a Blalock procedure.(A, B) Mid-esophageal view. The two atrioventricular valves (tricuspid and mitral) open in a single ventricle (V). (C, D) Transgastricview. Note the thickened septal part of the ventricle (LA, left atrium; RA, right atrium).low cardiac output. Those with unobstructed great arteriesdevelop pulmonary overcirculation with reduction of thepulmonary vascular resistance. A minority of patientspresent a well-balanced circulation with some degree ofpulmonary stenosis preventing excessive pulmonaryblood flow.Adults with a single ventricle are separated into twogroups: first, a group of patients who either never requiredsurgery because of an acceptable well-balanced physiologyor who have undergone one or several palliative(non-Fontan) surgical procedures. The latter include theGlenn’s bidirectional cavopulmonary connection and avariety of other aortopulmonary shunts such as theBlaloch–Taussig subclavian to pulmonary artery branchshunt, the Pott’s anastomosis of the anterior wall of theAo to the posterior wall of the left pulmonary artery andthe Waterston shunt between the ascending Ao and theright pulmonary artery. The other group includes patientswho have undergone a repair where the systemic venousreturn is diverted to the pulmonary artery circulationwithout passing through a subpulmonary ventricle, a principlewhich is now known as the Fontan procedure.(A)(B)ALVRVFigure 24.34 Mid-esophageal view of a hypoplastic left heart. Note the small left ventricle (LV) and the large right ventricle (RV).The image was obtained as a preoperative evaluation for a third stage Fontan procedure (A, atrium).