Single institution experience with the Ladd’s procedure in patients with heterotaxy and stage I palliated single-ventricle

Table 1 Heterotaxy patients

Reason for GI surgery	Studies	Segmental anatomy	Cardiac anatomy	Visceral abnormality	Cardiac procedure	GI surgery	Age at ladd	Intra/postop Complications	Outcome	Current GI status
Poor PO intake, severe GE Reflux	UGI/SBFT	I, D, D	Unbalanced CAVC, PA, LSVC	IRA	PDA stent	Ladd, Roux-en-Y jejunostomy	6 wk	None	Alive	At 5 yr had jejunal perforartion resulting in laparotomy and Nissen. Feeds PO and Gtube
Poor PO intake, severe GE Reflux	UGI/SBFT	A, D, D	Unbalanced CAVC, TAPVR, PA, RPA stenosis	IRA	3.5 mm central shunt placement, TAPR repair, RPA plasty	Ladd, Nissen/Gtube	6 wk	None	Alive	No obstruction or GI surgeries. Feeds PO and Gtube
Severe GE Reflux, Vocal cord paralysis with aspiration	UGI/SBFT Mod. Barium Swallow	I, D, S	Dextrocardia, TA, Unbalanced CAVC, Coarctation	IRA	Norwood with 3.5 mm Modified BT shunt	Ladd, Nissen/Gtube	8 wk	None	Alive	No obstruction or GI surgeries. Gtube is removed and now eats entirely PO
Poor PO intake, severe GE Reflux	UGI/SBFT	A, L, D	Unbalanced CAVC, TAPVR, PA	IRA	3.5 Modified BT shunt, TAPVR repair, PA plasty	Ladd, Nissen/Gtube	8 wk	None	Outpatient death from bowel perforation	N/A
Poor PO intake, TE Fistula repair, severe GE Reflux	UGI/SBFT	S, D, D	DORV, right atrial isomerism, BLSVC, CAVC, PS	IRA	PDA stent	Ladd, Nissen/Gtube	5 wk	None	Alive	No obstruction or further GI surgeries. Gtube fed only
Poor PO feeding, GE Reflux,	UGI/SBFT	I, D, D	Dextrocardia, Unbalanced CAVC, TAPVR, PA	IRA	3.5 mm central shunt, TAPVR repair, PA plasty	Ladd, Nissen/GT	6 wk	None	Alive	No obstruction or GI surgeries. Feeds PO and Gtube
Poor PO intake, feeding intolerance, GE Reflux	UGI/SBFT	I, D, D	Unbalanced CAVC, Pulmonary atresia	IRA	3.5 mm Modified BT shunt	Ladd, Nissen/Gtube	6 wk	None	Alive	No obstruction or GI surgeries, All feeds via Gtube
Poor PO feeding, GE reflux, aspiration	UGI/SFT, Modified barium swallow	A, L, L	Unbalanced CAVC, TAPVR, Pulmonary atresia	IRA	4.0 mm Modified BT shunt, TAPVR repair	Ladd, Nissen/Gtube	5 wk	None	Alive	No obstruction or GI surgery. All feeds via Gtube

PA: Pulmonary atresia; BT: Blaylock-Taussig; CAVC: Complete atrioventricular canal; TAPVR: Total anomalous pulmonary venous return; GI: Gastrointestinal; GT: Gastrostomy tube; GE: Gastroesophageal; PO: Per oral; TA: Tricuspid atresia; IRA: Intestinal rotation and fixation anomaly; UGI/SBFT: Upper GI with small bowel follow through; DORV: Double outlet right ventricle.