title: Staged surgical approach in neonates with a functionally single ventricle and arch obstruction: pulmonary artery banding and aortic arch reconstruction before placement of a bidirectional cavopulmonary shunt in infants.
abstract: The success rate of right-heart bypass surgery in patients with a functionally single ventricle (f-SV) and systemic obstruction is low. In patients with a high risk of subaortic stenosis, we performed an initial step of pulmonary artery banding (PAB) and arch reconstruction before placing a bidirectional cavopulmonary shunt (BCPS) in infants with or without Damus-Kaye-Stansel (DKS) anastomosis. We assessed the success of right-heart bypass surgery. Between October 2003 and August 2008, we performed surgery in 19 neonates (median age 5 days) with f-SV and arch obstruction. Extended aortic arch anastomosis, with or without distal arch augmentation, was performed in 10 patients, and subclavian flap aortoplasty was performed in 9 patients. The circumference of the PAB was determined as the individual patient's body weight in kilograms plus 16.2 +/- 3.7 mm. Eighteen of 19 infants (95%) underwent successful BCPS placement at a median age of 7.8 months. DKS anastomosis was performed concomitantly during BCPS placement in 11 infants in whom subaortic stenosis was morphologically suspected but not demonstrated physiologically. As our first-stage operation, arch reconstruction plus PAB provided high success rates for right-heart bypass operations. This strategy is not leading, but it is a reliable approach for progression along a Fontan pathway.
authors.affiliation: Department of Cardiovascular Surgery, Kanagawa Children's Medical Center, 2-138-4 Mutsukawa, Minami-ku, Yokohama, Kanagawa 232-8555, Japan. n-c.kaji@f6.dion.ne.jp
authors.forename: Noriyoshi
authors.initials: N
authors.lastname: Kajihara
authors.forename: Toshihide
authors.initials: T
authors.lastname: Asou
authors.forename: Yuko
authors.initials: Y
authors.lastname: Takeda
authors.forename: Yoshimichi
authors.initials: Y
authors.lastname: Kosaka
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nagafuchi
authors.forename: Ryusuke
authors.initials: R
authors.lastname: Oyama
authors.forename: Seiyo
authors.initials: S
authors.lastname: Yasui
mesh_terms: D001013:Aorta, Thoracic / Q000002:abnormalities / Q000601:surgery; D001017:Aortic Coarctation / Q000601:surgery*; D001020:Aortic Stenosis, Subvalvular / Q000601:surgery; D018729:Fontan Procedure; D006330:Heart Defects, Congenital / Q000601:surgery; D006352:Heart Ventricles / Q000002:abnormalities*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011651:Pulmonary Artery / Q000601:surgery; D012086:Reoperation; D016896:Treatment Outcome; D014694:Ventricular Outflow Obstruction / Q000601:surgery*