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The Systemic Right Ventricle in Biventricular and Univentricular Circulation

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The Right Ventricle in Health and Disease

Part of the book series: Respiratory Medicine ((RM))

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Abstract

In this chapter we describe the role of the systemic right ventricle in a biventricular circulation and the univentricular heart. The ventriculo-ventricular interaction of the subaortic right ventricle is discussed in the context of (1) congenitally corrected transposition and (2) the systemic ventricle after atrial switch operation; the right ventricle as a univentricular heart based on the experiences of a hypoplastic left heart syndrome. Novel therapeutical strategies are presented in the form of pulmonary artery banding for the failing systemic right ventricle and for the retraining of the subpulmonary left ventricle; in addition, some pharmacological treatment aspects for the failing right ventricle are addressed as well as the strategy of a so-called hybrid approach which combines bilateral pulmonary banding, duct stenting, and atrioseptostomy. Importantly we highlight, what we need to learn in order to expand the therapeutic options for the majority of patients with normal anatomy but a failing subpulmonary ventricle.

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Author information

Authors and Affiliations

  1. Department of Pediatric Cardiology, Justus-Liebig-University, Feulgenstrasse. 10-12, Giessen, 35385, Germany

    Heiner Latus M.D., Christian Apitz M.D. & Dietmar Schranz

Authors
  1. Heiner Latus M.D.
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  2. Christian Apitz M.D.
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  3. Dietmar Schranz
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Corresponding author

Correspondence to Dietmar Schranz .

Editor information

Editors and Affiliations

  1. Department of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA

    Norbert F. Voelkel

  2. Pediatric Heart Center, Justus-Liebig University, Giessen, Germany

    Dietmar Schranz

Electronic Supplementary Material

Below is the link to the electronic supplementary material.

MRI shows a double outlet right ventricle with transposition of the great arteries and subpulmonary obstruction (MOV 296 kb)

Shows in MRI four-chamber view ccTGA with atrio (LA, RA) to ventricular (RV, LV) discordance, respectively. Dominant is the dilated left atrium and systemic right ventricle associated with tricuspid (systemic atrioventricular valve) regurgitation, the interatrial septum is bulging to the right. (AVI 1380 kb)

Lateral view at the LA-RV-AO before and after pulmonary banding combined with tricuspid valve reconstruction; the surgical strategy improved the function of the systemic RV and reduced significantly the LA enlargement and consecutively the patient’s functional status. (AVI 1402 kb)

(AVI 356 kb)

Shown is echocardiographic four-chamber view of an infant with hypoplastic left heart syndrome consisting of mitral valve stenosis and aortic valve atresia. The functional single right ventricle has a sufficient systolic function. At the atrial level systemic and pulmonary vein mixed to one inflow through the tricuspid valve in the volume dilated RV. Stenting of the atrial septum became necessary for unloading the left atrium (AVI 10051 kb)

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Latus, H., Apitz, C., Schranz, D. (2015). The Systemic Right Ventricle in Biventricular and Univentricular Circulation. In: Voelkel, N., Schranz, D. (eds) The Right Ventricle in Health and Disease. Respiratory Medicine. Humana Press, New York, NY. https://doi.org/10.1007/978-1-4939-1065-6_6

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  • DOI: https://doi.org/10.1007/978-1-4939-1065-6_6

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  • Publisher Name: Humana Press, New York, NY

  • Print ISBN: 978-1-4939-1064-9

  • Online ISBN: 978-1-4939-1065-6

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