Document Detail


Subaortic obstruction in univentricular heart: results using the double barrel Damus-Kaye Stansel operation.
MedLine Citation:
PMID:  18996717     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: We review our experience with relief of subaortic obstruction in univentricular hearts following pulmonary artery banding (PAB) with double barrel Damus-Kaye Stansel procedure (DKS) and subsequent staged palliation to Fontan. The purpose was to determine if PAB alters semilunar valve function after the double barrel DKS procedure and if this staged approach negatively influences the achievement of Fontan palliation. METHODS: From January 1990 to March 2006, 27 patients underwent PAB (mean 22 days, range 1-150 days; 3.4kg) and coarctation as corrected simultaneously in 18 (18/27) 66%. These 27 patients subsequently had PA debanding and double barrel DKS connection at a mean age of 10.2 months (range 0.3-58 months). Pulmonary flow was established with a bidirectional Glenn in 14 patients; modified Blalock in 6, Glenn with modified Blalock in 5 and completion Fontan in 2 patients. RESULTS: There were six early deaths (22%) following DKS: four patients receiving DKS with systemic shunt and two receiving bidirectional Glenn and systemic shunt. Patients receiving DKS with bidirectional Glenn shunt had a significantly lower mortality than patients who had a DKS with systemic shunt alone or in combination with a Glenn (p<0.03). Single ventricle to aortic gradient was reduced from 27.5+/-18mmHg to 3.4+/-2mmHg following double barrel DKS procedure (p<0.001). Aortic and pulmonary insufficiency was trace to mild in all patients. Nineteen of 21 survivors (90%) have completed Fontan with no early and three late deaths. Two patients are completion Fontan candidates. CONCLUSIONS: PAB (+/-coarctation repair) with interval double barrel DKS is effective palliation for univentricular heart and excessive pulmonary blood flow. PAB does not create significant pulmonary insufficiency and subsequent DKS effectively relieves single ventricle to aortic gradient. Optimal second stage pulmonary blood flow is usually established with a bidirectional Glenn. The need for a Blalock shunt or a Glenn plus a Blalock is associated with increased mortality.
Authors:
Andrew C Fiore; Mark Rodefeld; Palaniswamy Vijay; Mark Turrentine; Christine Seithel; Mark Ruzmetov; John W Brown
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Publication Detail:
Type:  Evaluation Studies; Journal Article; Multicenter Study     Date:  2008-11-08
Journal Detail:
Title:  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery     Volume:  35     ISSN:  1873-734X     ISO Abbreviation:  Eur J Cardiothorac Surg     Publication Date:  2009 Jan 
Date Detail:
Created Date:  2008-12-22     Completed Date:  2009-11-04     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8804069     Medline TA:  Eur J Cardiothorac Surg     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  141-6     Citation Subset:  IM    
Affiliation:
Divisions of Cardiothoracic Surgery, Cardinal Glennon Children's Hospital, St. Louis University School of Medicine, St. Louis, MO, USA.
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MeSH Terms
Descriptor/Qualifier:
Anastomosis, Surgical / methods
Aorta / surgery*,  ultrasonography
Aortic Coarctation / surgery
Child, Preschool
Epidemiologic Methods
Female
Fontan Procedure
Heart Defects, Congenital / surgery*,  ultrasonography
Heart Ventricles / abnormalities,  surgery
Humans
Infant
Male
Pulmonary Artery / surgery*,  ultrasonography
Treatment Outcome
Ventricular Outflow Obstruction / surgery*,  ultrasonography
Comments/Corrections
Comment In:
Eur J Cardiothorac Surg. 2009 Jan;35(1):147-8   [PMID:  19046897 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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