Cardiology in the Young

Review Article

Extending the surgical boundaries in the management of the left ventricular outflow tract obstruction in discordant ventriculo-arterial connections – a surgical and morphological study

Paula Martinsa1, Vi Trana2, Gemma Pricea2, Victor Tsanga2 and Andrew C. Cooka2 c1

a1 Paediatric Cardiology Department, Paediatric Hospital of Coimbra, Portugal

a2 Cardiac Unit, Institute of Child Health, London, United Kingdom


When there is obstruction of the left ventricular outflow tract, there are several surgical approaches to the repair of discordant ventriculo-arterial connections in the setting of concordant atrioventricular connections. Choosing the optimal technique demands not only knowledge of the different surgical procedures, but also the understanding of the particular anatomic features present in a specific patient. These requisites are then essential to plan the operation, to foresee some difficult situations, and to avoid post-operative complications. In this review, we assess all these surgical and anatomic aspects, focussing on their relative importance in clinical assessment.

(Accepted September 07 2007)


c1 Correspondence to: Dr Andrew C Cook, Senior Lecturer, Cardiac Unit, Institute of Child Health, 30 Guilford St, London WC1N 1EH. Tel: +44 (0)207 905 2295; Fax: +44 (0)207 905 2324; E-mail: