Management of systemic outlet obstruction in patients undergoing single ventricle palliation.
Early or late systemic outlet obstruction in patients undergoing staged palliation for single ventricle variants may preclude a successful Fontan circulation. In assessing the patient presenting with real or impending obstruction, the surgeon is justified in pursuing an aggressive approach in protecting ventricular and semilunar valve function. Options include subaortic resection (transventricular, transatrial, or via a semilunar valve), modifications of the Damus-Kaye-Stansel connection, or a palliative arterial switch operation. In this review, the various options will be discussed and presented in the context of application to specific morphologic elements that make one more favorable than another in an individual patient.
Fraser
Charles D
CD
Department of Surgery, Baylor College of Medicine, Houston, TX, USA. charlesf@bcm.tmc.edu
D001020:Aortic Stenosis, Subvalvular / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D018729:Fontan Procedure; D006330:Heart Defects, Congenital / Q000601:surgery*; D006352:Heart Ventricles / Q000002:abnormalities*; D006801:Humans; D007231:Infant, Newborn; D010166:Palliative Care; D014694:Ventricular Outflow Obstruction / Q000601:surgery*