Complex Biventricular Repair for Children - Program Overview

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The Boston Children's Hospital Heart Center’s Complex Biventricular Repair Program is a multidisciplinary effort to provide an option for “two ventricle” circulation in newborns and children who are being considered for, or have undergone, single ventricle repair.  Novel procedures and innovative technology have allowed us to achieve a two ventricle circulation in children who were not considered candidates for this at most other centers. We treat each patient with a tailored, personalized approach, based upon the unique characteristics of every child’s heart.

Cardiac Caregiver Sitaram Emani, MD


No two children have the same heart. Our program tailors a unique, personalized approach for each boy or girl, based on a thorough diagnostic and physical assessment.”

~ Sitaram Emani, MD, Director of the Complex Biventricular Repair Program

The Complex Biventricular Program – part of the top-ranked pediatric heart center in the U.S. – includes pediatric cardiologists, cardiac surgeons, cardiac anesthesiologists, intensive care doctors, nurses and nurse practitioners who are dedicated to caring for these special children. We take a very individualized approach in order to find the best method to evaluate, diagnose and treat your child. Our team ensures continuity of care for each child—from diagnosis to post-operative treatment. After patients returning home, we stay in close contact with them and their local health care team to monitor status and guide further treatment. We also strive to maintain open, clear and responsive communication with families throughout the process.


What is complex biventricular repair?

The heart has two major pumping chambers - the right and left ventricles. The right ventricle (sometimes called the lung pump) pumps low oxygen (“blue”) blood to the lungs to pick up oxygen. The left ventricle (sometimes called the body pump) pumps high oxygen (“red”) blood to the body. Structures on one side of the heart may be too small (hypoplastic) to pump blood to the lungs or to the body leading to the diagnosis of a “single ventricle heart defect.” In some patients, the position and orientation of the heart structures presents a challenge for achieving a normal two ventricle circulation, which prompts single ventricle repair.

Most babies with a single ventricle circulation undergo three heart surgeries resulting in the single ventricle Fontan circulation. Due to concerns about the long-term prognosis for this type of single ventricle repair, we try, whenever possible, to achieve a two-ventricle (biventricular) heart repair.  A complex biventricular repair is performed using innovative catheter and surgical interventions to create a heart that has two pumping chambers.  In some patients, the biventricular repair can be done as the initial procedure. In others, a step-wise approach is initially utilized in which the single ventricle supports the circulation as the smaller ventricle is rehabilitated by catheter and surgical treatments with the goal of eventual conversion to biventricular circulation. Based on the unique characteristics of your child’s heart, our advanced imaging group allows us determine the right customized approach and monitor the progress of ventricular recruitment. To date, many patients have benefitted from this strategy. Not all patients are candidates for biventricular repair, and there are risks involved with this type of approach, which is why it is important to have a dedicated team evaluating each patient and monitoring the outcome carefully.


The heart disorders we treat include:

Treating more of these complex pediatric patients than any other institution in the world, we are here to offer you a customized second opinion evaluation and care plan. In 2012 alone, we saw about 80 children with heterotaxy syndrome and 120 with HLHS. In 2013, we performed 1,320 cardiac catheterizations, 860 open-heart surgeries and 523 closed-heart surgeries.

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The future of pediatrics will be forged by thinking differently, breaking paradigms and joining together in a shared vision of tackling the toughest challenges before us.”
- Sandra L. Fenwick, President and CEO