Two-dimensional echocardiographic detection of pulmonary venous channel stenosis after Senning's operation.

Abstract

Stenosis of the common pulmonary venous (PV) channel after Senning's operation for complete transposition of the great arteries is a serious problem, and a method for noninvasive diagnosis is highly desirable. Therefore, our purpose was to devise a method to diagnose PV channel stenosis noninvasively. The newly created common PV channels were measured and the short-axis views of the left ventricle were observed by means of two-dimensional echocardiography in 16 patients who had undergone Senning's procedure. In seven patients we used the original procedure and in nine patients we used a modified procedure with a pedicled pericardial patch. The shape of the left ventricle became round abruptly when the width of the PV channel decreased below a critical value (a range of 6 to 9 mm). Three patients with a relatively round-shaped left ventricle and a narrow PV channel (below 9 mm) were all confirmed to have PV channel stenosis at reoperation. All of the patients with a wide PV channel (above 10 mm) and a flat-shaped left ventricle were in good condition both clinically and as determined from the catheterization data. After the operation, patients who had tricuspid regurgitation, pulmonary vascular obstruction, or residual left ventricular outflow tract stenosis had a relatively round-shaped left ventricle even though the PV channel was wide enough (above 10 mm). Measurement of the PV channel confirmed the effects of these conditions. Correct diagnosis of PV channel stenosis can therefore be made by observing the shape of the left ventricle and by measuring the PV channel.