Biventricular Repair Program
The affiliated, multidisciplinary team of pediatric heart surgeons, pediatric cardiologists, and other specialists at the Children’s Heart Center1 at Children’s Memorial Hermann Hospital aims to give each child the opportunity to live a normal life by restoring the normal function of his or her heart with the greatest degree of safety.
The affiliated team offers patients specialized and innovative treatments such as the biventricular repair, biventricular conversion, and ventricular recruitment for some of the most complex issues involving a single ventricle defect. As the only program in Texas2 with the capability to provide these advanced treatment options, the team works to rearrange the connections of a child’s heart, starting with a single functional pumping chamber or ventricle and converting it into a normal, two-ventricle arrangement.
Full biventricular repairs are an alternative option for many newborns and children who would typically undergo or have previously undergone traditional treatment methods (i.e., surgical procedures including the Norwood, Glenn, and Fontan operations). This capability is very unique and progressive, and it can result in fewer surgeries and better long-term quality of life for many children.
What is a Biventricular Repair?
The normal heart has four chambers: two upper chambers called atria, which receive blood into the heart, and two lower chambers called ventricles, which pump blood out of the heart. Many children with a congenital heart defect have only one functional ventricle, or pumping chamber, that is able to pump blood effectively.
Biventricular repair, biventricular conversion, and ventricular recruitment are treatment options for complex congenital heart patients born with a single ventricle defect, or a small right or left heart.
Traditionally, the treatment for these types of heart conditions involves a single ventricle palliation: a series of open heart surgeries (the Norwood, Glenn, and Fontan procedures) to allow the single working ventricle to pump blood to the body, leaving the blue blood to flow passively to the lungs. This traditional treatment option, while effective in many patients, can ultimately lead to heart failure, decreased quality of life, and potential need for heart transplantation.
For many children, biventricular repair and biventricular conversion offer an alternative, advanced treatment option for those previously managed as single ventricles. The types of biventricular repair procedures are listed below:
- Biventricular Repair – an innovative procedure requiring specialized expertise aimed to create pathways and chambers that allow for a normal, two-ventricle arrangement in the patient’s heart. The affiliated team at the Children’s Heart Center offers a full biventricular repair in the newborn period, enabling some patients the opportunity to avoid numerous surgeries. Many children traditionally referred for the Norwood procedure or the single ventricle pathway treatment option can now be managed as two-ventricle, full repairs from the birth.
- Biventricular Conversion – For patients who have previously received single ventricle palliation (the Norwood, Glenn, and Fontan procedures), this procedure technique aims to convert them back to a normal, two-ventricle arrangement.
- Ventricular Recruitment – staged biventricular repair procedures to recruit (make grow) a smaller or borderline ventricle and enable a complete biventricular repair in the future.
Diagnosis and Advanced Imaging
Congenital heart defects may be diagnosed during pregnancy with a fetal echocardiogram, which is a specialized ultrasound of the fetal heart. The affiliated physicians in the Fetal Cardiology Program at The Fetal Center will confirm a diagnosis and prepare a delivery plan for both mom and baby. The multidisciplinary team of affiliated fetal and pediatric heart specialists will also develop the baby's immediate treatment plan following delivery.
If the heart defect is not diagnosed in utero, and suspicion of a heart defect develops after the baby is born, a pediatrician will refer the patient to a neonatologist or a pediatric heart specialist to determine the diagnosis. At Children’s Memorial Hermann Hospital, our advanced diagnostic imaging includes echocardiography, cardiac MRI, CT scanning and other technology. Imaging scans performed help the affiliated team determine the appropriate plan of care.
Comprehensive Evaluation and Treatment
At the Children’s Heart Center, the affiliated team tailors each plan of care to help ensure that every child receives the best individualized option with the minimum amount of risk. Along with a thorough review of pediatric imaging results, the affiliated team provides a comprehensive evaluation of each patient and consults with the patient’s family to determine the best treatment approach for the child. Each patient is evaluated to determine if he or she is a candidate for a biventricular repair procedure.
For patients who meet the criteria to undergo a biventricular repair, this treatment approach can result in fewer operations throughout a child’s lifetime and has the potential to improve long-term quality of life. There are risks associated with all treatment options, but the affiliated team’s experience has shown that biventricular repairs and conversions offer children an excellent opportunity for a normal life. Not all patients qualify for this procedure, but each child will be carefully evaluated in an effort to find hope and solutions for each patient.
The affiliated team utilizes other advanced treatment options and techniques, including congenital heart optimization, for children who may not meet the specific criteria for a biventricular repair procedure.
Conditions Treated Through Biventricular Repair
Below is a list of heart conditions that may be treated with a biventricular repair, biventricular conversion, or ventricular recruitment approach in children who qualify:
What Follow-Up Care is Necessary?
The affiliated team may follow a child’s care throughout life into adulthood. Patients will see a cardiologist regularly as well as obtain an echocardiogram and other studies as needed. The affiliated team individualizes care to the needs (and anatomy) of each child.
Why Choose Children’s Memorial Hermann Hospital?
At the Children’s Heart Center at Children’s Memorial Hermann Hospital, patients with congenital or acquired heart disorders are provided with hands-on specialized care 24/7 from a team of affiliated physicians and specialty-trained nurses who aim to deliver the best possible outcomes. In collaboration with various subspecialties, the affiliated team provides comprehensive care for newborns, children and adolescents, with a smooth transition into adult congenital cardiac care.
The affiliated team has the experience and expertise necessary to offer services, including, but not limited to:
- Minimally invasive cardiac catheterization and cardiac surgery procedures
- Minimally invasive transcatheter pulmonary valve (TPV) therapy
- Full repairs for complex congenital heart defects in newborns
- Biventricular repairs and biventricular conversions
- Congenital heart optimization
- Valve repairs and preservation
- Treatment for adult congenital heart disease
With a Level IV Neonatal Intensive Care Unit (NICU) and the Children’s Heart Center Intensive Care Unit (HCICU), Children’s Memorial Hermann Hospital offers patients access to the highest level of specialized cardiac care.
Affiliated physicians evaluate patients at affiliated UT Physicians clinic locations and perform all inpatient procedures and treatments at Children’s Memorial Hermann Hospital.
Pediatric Cardiovascular Surgery Clinic
The University of Texas Health Science Center Professional Building
6410 Fannin, Suite 950
Houston, TX 77030
Clinic Phone: (832) 325-7234
Nurse Line: (713) 500-5746
1 The Children’s Heart Center at Children’s Memorial Hermann Hospital is affiliated with the physicians at McGovern Medical School at UTHealth and the UT Physicians Pediatric Outpatient Clinics across Greater Houston.
2 As of March 2018.
Note: The information presented on this page is educational and is intended to develop a general knowledge of the condition and/or procedure. It is not intended as medical advice or the practice of medicine. Specific aspects of your condition, expected outcomes, and care should be addressed and answered after consultation with your physician. Not all affiliated physicians are Memorial Hermann employees.
03/2018 – This page was updated and approved by an affiliated pediatric physician at the Children’s Heart Center.