Advertisement

Pediatric Cardiology

, Volume 27, Issue 5, pp 594–599 | Cite as

Pulmonary Artery Banding Before the Damus–Kaye–Stansel Procedure

  • Yun Hee Chang
  • Woong-Han KimEmail author
  • Jae Young Lee
  • Soo-Jin Kim
  • Cheul Lee
  • Seong Wook Hwang
  • Si Chan Sung
Article

Abstract

Subaortic stenosis (SAS) in a single ventricle leads to myocardial hypertrophy and compromises Fontan results. Moreover, controversy exists concerning the optimal surgical strategy for relieving SAS. We have applied pulmonary artery banding (PAB) before the Damus–Kaye–Stansel procedure (DKS), and here we analyze factors that influence systemic ventricular compliance. Thirteen patients underwent PAB before DKS. Median PAB duration was 5.5 months (range, 20 days to 17.7 months). Procedures administered concomitantly with DKS were Blalock–Taussig shunt (n = 6), bidirectional cavopulmonary shunt (n = 5), and Fontan operation (n = 2). All survived and were doing well after a median follow-up 2.7 years. Cardiac catheterization before DKS showed that the mean pressure gradient across the systemic ventricular outflow tract and PAB were 20.6 ± 10.1 and 67.4 ± 10.2 mmHg, respectively. After DKS, systemic ventricular end diastolic pressure (SVEDP) was significantly correlated with PAB duration (r = 0.65, p = 0.022), but not with PAB or systemic ventricle outflow tract pressure gradients. After DKS, SVEDP decreased or fell to within the range in patients with PAB duration less than 7 months (p < 0.05). Seven patients had a successful Fontan operation, and 6 without risk factors are waiting operation. SVEDP was found to be correlated with PAB duration, and our findings indicate that short-term PAB can be considered a safe option in patients with a single ventricle and SAS.

Keywords

Congenital heart disease Pulmonary vascular resistance Ventricle 

References

  1. 1.
    Alvarez Diaz F, Hoyo EH, De Leon JP, et al. (1975) Tecnica de correcion anatomica de la transposicion complete de grandes vasos. Rev Esp Cariol 28:255Google Scholar
  2. 2.
    Anderson RH, Becker AE, Van Mierop LHS (1977) What should we call the “crista”? Br Heart J 39:856–859PubMedGoogle Scholar
  3. 3.
    Bradley SM, Simsic JM, Atz AM, Hugh Dorman B (2002) The infant with single ventricle and excessive pulmonary blood flow: results of a strategy of pulmonary artery division and shunt. Ann Thorac Surg 74:805–810PubMedCrossRefGoogle Scholar
  4. 4.
    Ceithaml EL, Puga FJ, Danielson GK, McGoon DC, Ritter DG (1884) Results of the Damus–Stansel–Kaye procedure for transposition of the great arteries and for double-outlet right ventricle with subpulmonary ventricular septal defect. Ann Thorac Surg 38:433–437CrossRefGoogle Scholar
  5. 5.
    Daenen W, Eyskens B, Meyns B, Gewillig M (2000) Neonatal pulmonary artery banding does not compromise the short-term function of a Damus–Kaye–Stansel connection. Eur J Cardiothorac Surg 17:655–657PubMedCrossRefGoogle Scholar
  6. 6.
    Damus PS (1975) Correspondence. Ann Thorac Surg 20:724–725CrossRefGoogle Scholar
  7. 7.
    Danielson GK, Tabry IF, Mair DD, Fulton RE (1978) Great vessel switch operation without coronary relocation for transposition of great arteries. Mayo Clinic Proc 53:675Google Scholar
  8. 8.
    DeLeon SY, Idriss FS, Ilbawi MN, et al. (1986) The Damus–Stansel–Kaye procedure: should the aortic valve or subaortic valve region be closed? J Thorac Cardiovasc Surg 91:747–753PubMedGoogle Scholar
  9. 9.
    DeLeon SY, Ilbawi MN, Tubeszewski K, Wilson WR Jr, Idriss FS (1991) The Damus–Stansel–Kaye procedure: anatomical determinants and modifications. Ann Throac Surg 52:680–687CrossRefGoogle Scholar
  10. 10.
    Franklin RC, Spiegelhalter DJ, Sullivan ID, et al. (1993) Tricuspid atresia presenting in infancy. Survival and suitability for the Fontan operation. Circulation 87:427–439PubMedGoogle Scholar
  11. 11.
    Freedom RM, Mawson JB, Yoo SJ, Benson LN (1997) Congenital Heart Disease: Text Book of Angiocardiography. Futura, NewYorkGoogle Scholar
  12. 12.
    Gentles TL, Gauvreau K, Mayer JE Jr, et al. (1997) Functional outcome after the Fontan operation: factors influencing late morbidity. J Thorac Cardiovasc Surg 114:392–403PubMedCrossRefGoogle Scholar
  13. 13.
    Huddleston CB, Canter CE, Spray TL (1993) Damus–Kaye–Stansel with cavopulmonary connection for single ventricle and subaortic stenosis. Ann Thorac Surg 55:339–346PubMedCrossRefGoogle Scholar
  14. 14.
    Ilbawi MN, DeLeon SY, Wilson WR Jr, et al. (1991) Advantages of early relief of subaortic stenosis in single ventricle equivalents. Ann Thorac Surg 52:842–849PubMedCrossRefGoogle Scholar
  15. 15.
    Karl TR, Watterson KG, Sano S, Mee RBB (1991) Operation for subaortic stenosis in univentricular hearts. Ann Throac Surg 52:420–428CrossRefGoogle Scholar
  16. 16.
    Kaye MP (1975) Anatomic correction of transposition of great arteries. Mayo Clinic Proc 50:638–640Google Scholar
  17. 17.
    Kirkiln JK, Blackstone EH, Kirklin JW, Pacifico AD, Bargeron LM (1986) The Fontan operation: ventricular hypertrophy, age and date of operation as risk factors. J Thorac Cardiovasc Surg 92:1049–1064Google Scholar
  18. 18.
    Lamberti JJ, Mainwaring RD, Waldman JD (1991) The Damus–Fontan procedure. Ann Thorac Surg 52:676–679PubMedCrossRefGoogle Scholar
  19. 19.
    Lan YT, Chang RK, Laks H (2004) Outcome of patients with double-inlet left ventricle or tricuspid atresia with transposed great arteries. J Am Coll Cardiol 43:113–119PubMedCrossRefGoogle Scholar
  20. 20.
    Malcic I, Sauer U, Stern H, et al. (1992) The influence of pulmonary artery banding on outcome after the Fontan operation. J Throac Cardiovasc Surg 104:743–747Google Scholar
  21. 21.
    McElhinney DB, Reddy VM, Silverman NH, Hanley FL (1997) Modified Damus–Kaye–Stansel procedure for single ventricle, subaortic stenosis, and arch obstruction in neonates and infants: midterm results and technique for avoiding circulatory arrest. J Thorac Cardiovasc Surg 114: 718–726PubMedCrossRefGoogle Scholar
  22. 22.
    Newfield EA, Nikaidoh H (1987) Surgical management of subaortic stenosis in patients with single ventricle and transposition of the great vessels. Circulation 76 (Suppl III):III-29–III-33Google Scholar
  23. 23.
    Stensel HC Jr (1975) A new operation for d-loop transposition of the great vessels. Ann Thorac Surg 19: 565–567CrossRefGoogle Scholar
  24. 24.
    Tchervenkov CI, Shum-Tim D, Beland MJ, Jutras L, Platt R (2001) Single ventricle with systemic obstruction in early life: comparison of initial pulmonary artery banding versus the Norwood operation. Eur J Cardiothorac Surg 19:671–677PubMedCrossRefGoogle Scholar
  25. 25.
    Van Praagh R, McNamara JJ (1968) Anatomic types of ventricular septal defect with aortic insufficiency. Am Heart J 75:604–619PubMedCrossRefGoogle Scholar
  26. 26.
    Waldman JD, Lamberti JJ, George L, et al. (1988) Experience with Damus procedure. Circulation 78(Suppl III):III-32–III-39Google Scholar
  27. 27.
    Webber SA, Sett SS, LeBlanc JG (1992) Univentricular atrioventricular connection with subaortic stenosis; a staged surgical approach. Ann Thorax Surg 54:344–347CrossRefGoogle Scholar
  28. 28.
    Yeh T Jr, Williams WG, McCrindle BW, et al. (1999) Equivalent survival following cavopulmonary shunt: with or without the Fontan procedure. Eur J Cardiothorac Surg 16:111–116PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • Yun Hee Chang
    • 1
  • Woong-Han Kim
    • 2
    • 4
    Email author
  • Jae Young Lee
    • 3
  • Soo-Jin Kim
    • 3
  • Cheul Lee
    • 3
  • Seong Wook Hwang
    • 3
  • Si Chan Sung
    • 1
  1. 1.Department of Thoracic and Cardiovascular SurgeryPusan National University HospitalBusanSouth Korea
  2. 2.Department of Thoracic and Cardiovascular SurgerySeoul National University Children’s HospitalSeoulSouth Korea
  3. 3.Department of Pediatric Cardiology and Thoracic and Cardiovascular SurgerySejong General Hospital, Sejong Heart InstituteKyungki-doSouth Korea
  4. 4.Department of Thoracic and Cardiovascular SurgerySeoul National University Children’s Hospital, Seoul National University, College of MedicineChongno-GuSouth Korea

Personalised recommendations