Usefulness of banding of the pulmonary trunk with single ventricle physiology at risk for subaortic obstruction.
This study addresses the effects of early banding of the pulmonary trunk and subsequent management of subaortic obstruction on the attainment of acceptable pre-Fontan hemodynamics in patients with a single left ventricle and aorta arising from an outflow chamber. We report our experience with 26 patients seen at our institution between January 1984 and December 1994 with a diagnosis of double-inlet left ventricle or tricuspid atresia and transposed great arteries, who were initially managed with pulmonary artery banding in the first 6 months of life. Pulmonary artery band placement was performed at an age of 2.1 +/- 1.8 months (mean +/- SD). Associated aortic arch abnormalities were present in 8 patients (31%). There were 19 patients (73%) who underwent treatment with a Damus-Kaye-Stansel procedure or ventricular septal defect (VSD) enlargement for a significant subaortic gradient or morphologically small VSD, alone or in conjunction with a Glenn or Fontan procedure. Eighteen of 26 patients (69%) underwent cardiac catheterization to assess their candidacy for the Fontan operation. Of this group, 16 were classified as low to moderate risk and 2 as high-risk Fontan candidates, based on hemodynamic criteria. The cumulative mortality for the entire cohort was 19%. Our results suggest that this high-risk group of patients can undergo effective pulmonary artery banding as an initial palliative step, with subsequent intervention for subaortic ob- struction when it is documented or highly suspected, and that acceptable pre-Fontan hemodynamic parameters can be achieved.
Jensen
R A
RA
Division of Pediatric Cardiology, University of California at Los Angeles School of Medicine, USA.
Williams
R G
RG
Laks
H
H
Drinkwater
D
D
Kaplan
S
S
D006328:Cardiac Catheterization; D004452:Echocardiography; D005260:Female; D018729:Fontan Procedure; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D008297:Male; D011651:Pulmonary Artery / Q000601:surgery*; D011662:Pulmonary Subvalvular Stenosis / Q000503:physiopathology / Q000601:surgery*; D014188:Transposition of Great Vessels / Q000601:surgery; D018785:Tricuspid Atresia / Q000601:surgery