Palliative arterial switch as first-line treatment before the fontan procedure in patients with single-ventricle physiology and subaortic stenosis.
OBJECTIVE
There are several techniques for the palliative treatment of patients with single-ventricle physiology, ventriculoarterial discordance and subaortic stenosis. The Fontan procedure relies on optimal initial palliation to avoid the development of subaortic stenosis (as well as ventricular hypertrophy and diastolic dysfunction).


METHODS
We present seven patients with single-ventricle physiology, transposition of the great arteries and subaortic stenosis, with low systemic output and high pulmonary flow, aged 21 to 383 days (median, 75) and weighing between 3.4 and 9.6kg (median, 4.2). All were treated with a palliative arterial switch, thus "switching" their subaortic stenosis to subpulmonary stenosis. Six patients also underwent aortic arch surgery, 4 an atrial septectomy, and 1 a subaortic membrane resection.


RESULTS
One patient died after surgery, another developed recoarctation, which was treated with an angioplasty, 3 patients reached the Glenn stage and 2 the Fontan stage. All had good ventricular function.


CONCLUSIONS
A palliative switch is an effective initial treatment for single-ventricle physiology with transposition of the great arteries and subaortic stenosis. This complex initial technique produces good results and allows the patient to progress to the Glenn or Fontan stage.
Cirugía Cardiaca, Hospital Carlos Haya, Málaga, Spain. Electronic address: giljaurena@gmail.com.
Juan Miguel
JM
Gil-Jaurena
Cardiología Pediátrica, Hospital Carlos Haya, Málaga, Spain.
Juan-Ignacio
JI
Zabala
Cardiología Pediátrica, Hospital Vall d'Hebron, Barcelona, Spain.
Dimpna C
DC
Albert
Cirugía Cardiaca, Hospital Carlos Haya, Málaga, Spain.
Rafael
R
Castillo
Cirugía Cardiaca, Hospital Carlos Haya, Málaga, Spain.
Mayte
M
González
Cirugía Cardiaca, Hospital Vall d'Hebron, Barcelona, Spain.
Luis
L
Miró
D001020:Aortic Stenosis, Subvalvular / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D018729:Fontan Procedure / Q000009:adverse effects / Q000379:methods*; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010166:Palliative Care / Q000379:methods*
Fontan; Glenn; Paliativo; Palliative; Single-ventricle; Switch; Transposición; Transposition; Univentricular; VSD; ventricular septal defect