title: Use of the Damus-Kaye-Stansel procedure prevents increased ventricular strain in Fontan candidates.
abstract: OBJECTIVE
  In Fontan candidates, we have recently been aggressively performing the Damus-Kaye-Stansel procedure (DKS) to prevent increased afterload on the systemic ventricle. The present study investigated the efficacy of the DKS procedure in terms of the ventricular function following a Fontan operation.
  
  
  METHODS
  Patients undergoing a Fontan operation were divided into three groups: DKS performed at the time of the bidirectional Glenn or Fontan operation (DKS group, n = 25); DKS not performed at any stage due to mild pulmonary stenosis (PS) (PS group, n = 23) and DKS not performed due to pulmonary atresia (PA) or severe PS (PA group, n = 24). Ventricular function, afterload on the systemic ventricle and atrioventricular valve regurgitation were compared between groups.
  
  
  RESULTS
  Cardiac catheterization before a Glenn or Fontan operation and at 1-year following the Fontan revealed significantly decreased ventricular end-diastolic pressure in the DKS group. The ventricular ejection fraction was significantly deteriorated in the PS group. Effective arterial elastance, as an index of total ventricular afterload, was increased after a Fontan in all groups, with a substantial increase in the PS group. As an index of ventricular mechanical efficiency, ventriculoarterial coupling was significantly increased only in the PS group. Cardiac ultrasonography revealed atrioventricular valve regurgitation above grade 3 persisting in many patients from the PS group. Semilunar valve function after DKS operation did not progress to moderate or worse in any patients.
  
  
  CONCLUSIONS
  The proactive performance of the DKS procedure prevents increased ventricular afterload, avoiding deterioration of cardiac function and contributing to improved long-term results following a Fontan operation.
authors.affiliation: Department of Cardiovascular Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan. iwai@mch.pref.osaka.jp
authors.forename: Shigemitsu
authors.initials: S
authors.lastname: Iwai
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kawata
authors.forename: Hideto
authors.initials: H
authors.lastname: Ozawa
authors.forename: Sanae
authors.initials: S
authors.lastname: Yamauchi
authors.forename: Hidefumi
authors.initials: H
authors.lastname: Kishimoto
mesh_terms: D000704:Analysis of Variance; D001794:Blood Pressure / Q000502:physiology*; D006328:Cardiac Catheterization / Q000379:methods; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D018729:Fontan Procedure / Q000379:methods*; D006349:Heart Valve Diseases / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D013318:Stroke Volume / Q000502:physiology*; D016276:Ventricular Function / Q000502:physiology