Neonatal pulmonary artery banding does not compromise the short-term function of a Damus-Kaye-Stansel connection.
BACKGROUND
The surgical approach of neonates with a functionally univentricular heart, transposition of the great arteries and excessive pulmonary bloodflow remains a challenge. Pulmonary artery banding remains a valuable option, but may induce ventricular hypertrophy, restriction of the bulboventricular foramen and dysplastic changes of the pulmonary valve. These secondary changes might compromise a later Damus-Kaye-Stansel connection because of pulmonary regurgitation but also a subsequent Fontan repair because of ventricular hypertrophy. The aim of this study is to investigate whether a previous pulmonary artery banding might compromise the function of a Damus-Kaye-Stansel connection.


METHODS
Thirteen neonates underwent pulmonary artery banding for functionally univentricular heart, transposition of the great arteries and pulmonary hypertension. Coarctation repair was associated in seven patients. All but one survived the operation. The twelve survivors underwent at a second stage a Damus-Kaye-Stansel connection after a mean interval of 1.1 years. The length of this interval was dictated by the degree of ventricular hypertrophy, the restriction of the bulboventricular foramen and by the degree of cyanosis. The Damus-Kaye-Stansel connection was constructed without any foreign material and with resorbable sutures. Associated procedures were: Glenn/hemi-Fontan (8 pts), Blalock-shunt (2 pts), biventricular correction with a homograft (1 pt), Fontan repair (1 pt). Four patients underwent successfully a Fontan repair at a third stage; seven patients are waiting for such repair.


RESULTS
All patients survived the second and third stage of this surgical approach. The mean follow-up after the Damus-Kaye-Stansel connection was 2.5 years. Echocardiography at the last follow-up revealed: PR grade 0 (1 pt), grade 1 (8 pts), and grade 2 (3 pts). All patients - except one patient with a systolic gradient of 24 mmHg - had laminar flow without any gradient in the ascending aorta. All patients, including those who underwent a definitive repair, are doing extremely well.


CONCLUSIONS
This experience demonstrates that a neonatal pulmonary artery banding does not compromise the function neither of a Damus-Kaye-Stansel connection nor a Fontan repair.
Daenen
W
W
University Hospital Gasthuisberg, B-3000, Leuven, Belgium. willem.daenen@uz.kuleuven.ac.be
Eyskens
B
B
Meyns
B
B
Gewillig
M
M
D000015:Abnormalities, Multiple / Q000000981:diagnostic imaging / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D018729:Fontan Procedure; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000601:surgery*; D006352:Heart Ventricles / Q000002:abnormalities* / Q000601:surgery*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging / Q000601:surgery*; D007231:Infant, Newborn; D008297:Male; D011651:Pulmonary Artery / Q000601:surgery*; D014188:Transposition of Great Vessels / Q000000981:diagnostic imaging / Q000601:surgery; D016896:Treatment Outcome; D014654:Vascular Patency; D014655:Vascular Resistance