The effect of pulmonary artery banding (PAB) and intracardiac repair on ventricular volumes was studied in 35 patients with uncomplicated complete atrioventricular canal (CAVC). Right ventricular (RV) and left ventricular (LV) end-diastolic volumes (EDV), determined from biplane cineaniograms using Simpson's rule, were expressed as a percent of normal mean (% NI) for body surface area; normal range (mean ± 1SD) is equivalent to 75%–125% NI. In preoperative studies (RV 26, LV 33), EDV averaged 149±51% and 184±50% NI, respectively,P vs NI<0.001 for both. In one of 26 patients, RV was very small (45% NI), and one of 33 had a small LV (70% NI). In 13 patients studied post-PAB, RVEDV and LVEDV were lower than in the preoperative group (P<0.001) and averaged 114±40% and 126±52% NI, respectively. In three of 13, RV was small (67% and 71% NI) or very small (56% NI). Three others had a small (71% and 67% NI) or very small (56% NI) LV.
In serial pre- and post-PAB studies (RV 9, LV 11), EDV was increased or normal in all preoperatively. In seven of nine, RVEDV decreased, falling below normal range in three. In eight of 11, LVEDV decreased, falling below normal in three. Following repair, RV and LVEDV averaged 80±20% NI and 126±23% NI, respectively, in seven patients. Four of the seven had RVEDV below normal range. Two patients with a small ventricle had intracardiac repair and did well. A previous report of small RV in patients with CAVC and PAB was corroborated and a similar incidence of small LV was found.
Serial pre- and post-PAB studies suggested a direct relationship between PAB and ventricular underdevelopment. The number of patients with small ventricles undergoing repair was too small to establish that their surgical risk is higher. Longer follow-up is necessary to tell whether small RV after repair will result in significant impairment of cardiac function.
Atrioventricular canal Ventricular volumes
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