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Pulmonary Artery Banding Before the Damus–Kaye–Stansel Procedure

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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.

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Authors and Affiliations

  1. Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Busan, South Korea

    Yun Hee Chang & Si Chan Sung

  2. Department of Thoracic and Cardiovascular Surgery, Seoul National University Children’s Hospital, Seoul, South Korea

    Woong-Han Kim

  3. Department of Pediatric Cardiology and Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute, Kyungki-do, Bucheon-shi, South Korea

    Jae Young Lee, Soo-Jin Kim, Cheul Lee & Seong Wook Hwang

  4. Department of Thoracic and Cardiovascular Surgery, Seoul National University Children’s Hospital, Seoul National University, College of Medicine, 28 Yongon-Dong, Chongno-Gu, Seoul, 110-744, South Korea

    Woong-Han Kim

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  1. Yun Hee Chang
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  3. Jae Young Lee
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  4. Soo-Jin Kim
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  5. Cheul Lee
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  7. Si Chan Sung
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Correspondence to Woong-Han Kim.

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Chang, Y.H., Kim, WH., Lee, J.Y. et al. Pulmonary Artery Banding Before the Damus–Kaye–Stansel Procedure. Pediatr Cardiol 27, 594–599 (2006). https://doi.org/10.1007/s00246-006-1038-4

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  • DOI: https://doi.org/10.1007/s00246-006-1038-4

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