Mid-term results for double inlet left ventricle and similar morphologies: timing of Damus-Kaye-Stansel.
BACKGROUND
Patients with double inlet left ventricle/l-transposition and similar morphologies have their systemic outflow traverse a bulboventricular foramen (BVF), which has a propensity to narrow over time. A Norwood procedure may be performed as the initial palliation. We prefer aortic arch repair and pulmonary artery banding, delaying Damus-Kaye-Stansel (DKS) or BVF resection until the second palliation. The aims of this study were to compare our results with those reported for Norwood strategy and examine the development of systemic outflow obstruction.


METHODS
Retrospective study of patients with double inlet left ventricle, L-TGA or similar morphology presenting between 1990 and 2000. Follow-up with clinical assessment, echocardiography and catheter studies.


RESULTS
Twenty-five patients had initial palliation with pulmonary artery banding with repair of any associated arch obstruction. Twelve patients had DKS performed as part of their second stage procedure, and 3 had DKS performed later for recurrent stenosis after prior enlargement of BVF. Six patients had BVF resection without later restenosis and 4 patients did not develop BVF stenosis. There was one early death (4%) and two late (8%). Fontan completion was achieved in 20 of the 22 survivors. There were no cases of DKS obstruction, no pulmonary valve had more than mild regurgitation.


CONCLUSIONS
Our approach achieves low operative mortality and morbidity and compares favorably with reported results for Norwood palliation. The significant rate of systemic outflow obstruction in those who did not undergo DKS at the second stage confirms the utility of early DKS in children with this morphology.
The Children's Hospital at Westmead, Adolph Basser Cardiac Institute, Westmead, NSW 2145, Australia.
Andrew J B
AJ
Clarke
Shingo
S
Kasahara
David R
DR
Andrews
Stephen G
SG
Cooper
Ian A
IA
Nicholson
Richard B
RB
Chard
Graham R
GR
Nunn
David S
DS
Winlaw
D001013:Aorta, Thoracic / Q000601:surgery; D001017:Aortic Coarctation / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data; D015331:Cohort Studies; D005500:Follow-Up Studies; D018729:Fontan Procedure; D006352:Heart Ventricles / Q000002:abnormalities* / Q000601:surgery*; D006801:Humans; D008026:Ligation; D010166:Palliative Care; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D011651:Pulmonary Artery / Q000601:surgery; D012189:Retrospective Studies; D013524:Surgical Flaps; D013997:Time Factors; D016896:Treatment Outcome; D018785:Tricuspid Atresia / Q000601:surgery; D014694:Ventricular Outflow Obstruction / Q000209:etiology