Volume 15, Issue 1, Pages (January 2012)

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Volume 15, Issue 1, Pages 88-95 (January 2012) Atrioventricular Valve Repair for Patient With Heterotaxy Syndrome and a Functional Single Ventricle Shunji Sano, Yasuhiro Fujii, Sadahiko Arai, Shingo Kasahara, Atsushi Tateishi Seminars in Thoracic & Cardiovascular Surgery: Pediatric Cardiac Surgery Annual Volume 15, Issue 1, Pages 88-95 (January 2012) DOI: 10.1053/j.pcsu.2012.01.014 Copyright © 2012 Elsevier Inc. Terms and Conditions

Figure 1 A variety of valve apposition techniques. Seminars in Thoracic & Cardiovascular Surgery: Pediatric Cardiac Surgery Annual 2012 15, 88-95DOI: (10.1053/j.pcsu.2012.01.014) Copyright © 2012 Elsevier Inc. Terms and Conditions

Figure 2 A CAVV orifice divided into two orifices using glutaraldehyde-treated autologous pericardial strip. Seminars in Thoracic & Cardiovascular Surgery: Pediatric Cardiac Surgery Annual 2012 15, 88-95DOI: (10.1053/j.pcsu.2012.01.014) Copyright © 2012 Elsevier Inc. Terms and Conditions

Figure 3 Actuarial survival by the Kaplan-Meier method. Actuarial survival was 71%, 71%, 67%, and 54% at 1, 3, 5, and 10 years after operation, respectively. Seminars in Thoracic & Cardiovascular Surgery: Pediatric Cardiac Surgery Annual 2012 15, 88-95DOI: (10.1053/j.pcsu.2012.01.014) Copyright © 2012 Elsevier Inc. Terms and Conditions

Figure 4 Actuarial moderate or severe AVV regurgitation free rate determined by the Kaplan-Meier method after initial AVV repair at the Okayama University Hospital. Actuarial moderate or severe AVV regurgitation-free rate was 86%, 71%, and 57% at 1,3, and 5 years after operation. Seminars in Thoracic & Cardiovascular Surgery: Pediatric Cardiac Surgery Annual 2012 15, 88-95DOI: (10.1053/j.pcsu.2012.01.014) Copyright © 2012 Elsevier Inc. Terms and Conditions

Figure 5 Reinforcement of edge-to-edge sutures. A strip of autopericardium is used for reinforcement of the edge-to-edge sutures. Seminars in Thoracic & Cardiovascular Surgery: Pediatric Cardiac Surgery Annual 2012 15, 88-95DOI: (10.1053/j.pcsu.2012.01.014) Copyright © 2012 Elsevier Inc. Terms and Conditions

Figure 6 Conduction system in patients with double inlet to a solitary ventricle with isomerism of the right appendages. Dual atrioventricular nodes are present and are connected by uninterrupted slings of conduction tissue. The nodes are positioned inferiorly and left inferolaterally in the absence of a ventricular septum. A strand of conduction tissue branches from the sling and merges with the ventricular myocardium toward the apex. A third hypoplastic node is often discovered in a superolateral position, but in neither is there a connection with the main axis. (Reprinted with permission.17) Seminars in Thoracic & Cardiovascular Surgery: Pediatric Cardiac Surgery Annual 2012 15, 88-95DOI: (10.1053/j.pcsu.2012.01.014) Copyright © 2012 Elsevier Inc. Terms and Conditions

Figure 7 Conduction system in patients with double inlet left ventricle with isomerism of left atrial appendages. Both atriums connect to a dominant left ventricle, through two AVVs in this heart. There is a gross malalignment of the ventricular septum, which lies approximately from right to left, and away from its normal position. It carries the atrioventricular conduction axis. A normally positioned atrioventricular node would fail to make contact with the ventricular conduction tissue. The result is that the connecting atrioventricular node lies in a right, superolateral position. It meets with the nonbranching bundle and then the bundle branches, which are orientated apically and toward the left, although proximally always running to the right (acute marginal) side of the ventricular septal defect (double headed arrow). (Reprinted with permission.17) Seminars in Thoracic & Cardiovascular Surgery: Pediatric Cardiac Surgery Annual 2012 15, 88-95DOI: (10.1053/j.pcsu.2012.01.014) Copyright © 2012 Elsevier Inc. Terms and Conditions

Figure 8 The approximate position of the sinus nodes in isomeric hearts. The approximate positions of the sinus nodes are shown in red in the (A) normal heart, (B) the mirror image of the normal, (C) in green, example of the grossly abnormal and unpredictable locations in isomerism of the left atrial appendages and (D) in red, isomerism of the right appendages. (Reprinted with permission.17) Seminars in Thoracic & Cardiovascular Surgery: Pediatric Cardiac Surgery Annual 2012 15, 88-95DOI: (10.1053/j.pcsu.2012.01.014) Copyright © 2012 Elsevier Inc. Terms and Conditions