Complex Reconfiguring of the Heart Through Septation and/or Intracardiac Baffles

In complex biventricular reconstruction, the goal is to redirect blood flow or reorient structures in the heart so that it can function more efficiently. A heart naturally has two inflows, two pumping chambers (the two lower ventricles of the heart), and two outflows. With certain congenital heart conditions, the heart is missing one or more of these elements, they are connected to each other in the wrong way, or they are in the wrong position. Some individuals have multiple heart anomalies that can be repaired simultaneously with these types of complex biventricular reconstruction.

Septation is the reconstruction of the heart into separate pumping chambers by adding material to create a wall within the heart. This term is commonly used when converting a single pump into a dual pump for patients with single-ventricle-type congenital heart disease.

Intracardiac baffle often goes along with septation. Baffles are structures that direct the flow of something—in this case, blood. In the heart, baffles are created with artificial material to separate the sides of the heart or to lead the blood down a desired pathway, helping to reroute it to where it needs to go.

Septation and/or intracardiac baffles (complex biventricular reconstruction) are used for the following conditions or combinations of conditions:

  • Double outlet right ventricle (DORV). DORV is a rare congenital heart defect where the pulmonary artery and the aorta both come from the right side of the heart, or ventricle, rather than the aorta coming from the left ventricle. Some complex forms of DORV are very difficult to surgically separate into two pumps, each with its own outflow, as in the normal heart.
  • Other conotruncal defects (structural defects of the outflow tract) with remote ventricular septal defect (VSD). In VSD, a common heart defect, there is a hole in the wall that separates the left and right ventricles. However, when a VSD is remote, it is not near a major artery and can often make separating the blood flow of the right and left sides of the heart challenging.
  • Straddling tricuspid valve. A rare heart defect where the underlying structure of the tricuspid valve (the valve that connects the upper and lower right chambers of the heart) straddles, or goes through, a ventricular septal defect (VSD).
  • Straddling mitral valve. A rare condition where the underlying structure of the mitral valve (the valve that connects the upper and lower left chambers of the heart) straddles, or goes through, a ventricular septal defect (VSD). While many heart centers believe that having a straddling valve automatically disqualifies a child from receiving biventricular reconstruction, we do not.
  • Supero-inferior ventricles and crisscross heart. Extremely rare heart defects where the ventricles become rotated during fetal development, which can cause certain parts of the heart to form incorrectly or to be connected to each other in an abnormal way.

A rare, complex genetic condition that occurs while a baby is developing in the womb. The syndrome can cause organs throughout the body to form incorrectly, including the heart. Heart defects are often very complex. Sometimes the heart and blood vessels are in the wrong positions within the chest cavity, among other problems.

Conversion from single ventricle or Fontan. Some babies are born with such complex heart disease that it is difficult to repair the heart and create the normal two pumps or ventricles. Through a series of surgeries ending with the Fontan surgery, the single pump is assigned to pump to the body, leaving no pump to the lungs. While this solution works for a while, it isn’t sustainable over a lifetime, and most single ventricle heart patients eventually need a heart transplant. By reconfiguring the heart via septation, we create two pumps and help avoid the complications of a single ventricle heart. If you’ve been told your child must have a single ventricle palliation (surgery), come see us for a second opinion. We can at times convert hearts back from single ventricle palliation/Fontan. Having two functional ventricles instead of one can dramatically change the trajectory of an individual’s life.