CARDIOVASCULAR JOURNAL OF AFRICA • Vol 23, No 5, June 2012
254
AFRICA
surgery to relieve the systemic outflow obstruction in transposed
DILV and TA patients who have developed subaortic stenosis
after pulmonary banding. However, Fiore and colleagues
recommended performing the operation between the third and
sixth month in order to prevent ventricular hypertrophy and
related development of compensatory diastolic dysfunction.
1
In our study group, this interval was approximately six months.
This period is appropriate to perform DKS and concomitant
BCPC operations, and there is then no need for a second
operation to perform a BCPC. Furthermore, in cases where
pulmonary blood flow is supplied by systemic-to-pulmonary
artery shunt, low diastolic blood pressure and overload may
worsen ventricular function.
Conclusion
In univentricular hearts with narrow interventricular connection,
subaortic stenosis increases over time. Relieving the stenosis in
the interventricular connection before the dominant ventricle’s
function deteriorates is important to do ahead of the Fontan
operation. This stenosis can be corrected safely with a DKS
operation.
References
1.
Fiore AC, Rodefeld M, ViJay P,
et al
. Subaortic obstruction in univen-
tricular heart: results using the double barrel Damus-Kaye Stansel
operation.
Eur J Cardiothorac Surg
2009;
35
(1): 141–148.
2.
Lan YT, Chang RK, Laks H. Outcome of patients with double-inlet left
ventricle or tricuspit atresia with transposed great arteries.
J Am Coll
Cardiol
2004;
43
(1): 113–119.
3.
Ilbawi MN, Deleon SY, Wilson WR,
et al
. Advantages of early relief
of subaortic stenosis in single ventricle equivalents.
Ann Thorac Surg
1991;
52
: 842–849.
4.
Freedom RM, Benson LN, Smallhorn JF, Williams WG, Trusler GA,
Rowe RD. Subaortic stenosis, the univentricular heart and banding of
the pulmonary artery: an analysis of the courses of 43 patients with
univentricular heart palliated by pulmonary artery banding.
Circulation
1986;
73
: 758–764.
5.
Pass RH, Solowiejczyk DE, Quaegebeur JM,
et al
. Bulboventricular
foramen resection: hemodynamic and electrophysiologic results.
Ann
Thorac Surg
2001;
71
: 1251–1254.
6.
Franclin RC, Spiegelhalter DJ, Anderson RH,
et al
. Double-inlet ventri-
cle presenting in infancy. I. Survival without definitive repair.
J Thorac
Cardiovasc Surg
1991;
101
: 767–776.
7.
Matitiau A, Geva T, Colan SD,
et al
. Bulboventricular foramen size in
infants with double inlet left ventricle or tricuspit atresia with trans-
posed great arteries: influence on initial palliative operation and rate of
growth.
J Am Coll Cardiol
1992;
19
(1): 142–148.
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