Usefulness and Surgical Strategies of Pulmonary Artery Banding in Functional Univentricular Heart.
- Author:
Woong Han KIM
1
;
Young Tak LEE
;
Pyo Won PARK
;
Soo Cheol KIM
;
Cheong LIM
;
Chan Young NA
;
Sam Se OH
;
Man Jong BACK
;
Jae Wook RYU
;
In Seok CHOI
;
Song Wok WHANG
;
Joon Yong CHO
;
Joon Hyuk KONG
;
Seog Ki LEE
;
Young Kwan PARK
;
Chong Whan KIM
Author Information
1. Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute, Puchon, Korea. woonghan@korea.com
- Publication Type:Original Article
- Keywords:
Pulmonary artery banding;
Univentricular heart;
Damus-Kaye-Stansel procedure;
Aortic arch obstruction;
Staging toward Fontan
- MeSH:
Aorta, Thoracic;
Constriction, Pathologic;
Fontan Procedure;
Heart*;
Hemodynamics;
Humans;
Infant;
Infant, Newborn;
Mortality;
Pulmonary Artery*;
Risk Factors;
Survivors
- From:The Korean Journal of Thoracic and Cardiovascular Surgery
2002;35(6):439-448
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: Pulmonary artery banding (PAB)in the functional univentricular heart (UVH)is a palliative procedure for staging toward the Fontan procedure;however,it is known to be a risk factor. MATERIALS AND METHOD: The records of all 37 patients with functional UVHs who underwent surgical palliation using PAB between September 1989 and August 1999 were reviewed retrospectively.We investigated the aortic arch obstruction,the development and progression of subaortic stenosis after PAB,and risk factor of mortality according to surgical method. RESULT: In 37 neonates and infants with single ventricular physiology,aortic arch obstruction was combined in 7.There were 6 early deaths (16.2%)after PAB and 3 late deaths (8.1%)after Fontan operation.The actuarial overall survival including early mortality at 3 and 5 years were 8 0 .7+/-6.6%,72.2 +/-8.2% respectively. Among 31 patients who survived PAB,27 patients (87.1%)could become candidates for Fontan operation;22 patients(71.0%)completed Fontan operation with 3 deaths and 5 were waiting bidirectional cavopulmonary shunt(BCPS)or Fontan operation (follow-up mean 4.5 year,minimal 2 year). Subaortic stenosis developed in 8 patients after PAB (8/29,27.6%);3 cases in the patients without arch anomaly (3/22,13.6%)and 5 in those with arch anomal y (5/7,71.4%).The subaortic stenosis was managed with Damus-Kaye-Stansel procedure (DKS)in 6 patients without operative mortality and conal septum resection in 2 without long-term survivor. Analysis of risk factors established that aortic arch obstruction was strongly associated with subaortic stenosis (p<0.001).The only risk factor of late mortality was Fontan procedure without staged palliation by BCPS (p=0.001). CONCLUSION: PAB is effective as an initial palliative step in functional UVH.And the high risk group of patients with aortic obstruction can undergo effective short-term PAB as an initial palliative step,with subsequent DKS for subaortic stenosis.This strategy,initial PAB and careful surveillance,and early relief of subaortic stenosis can maintain acceptable anatomy and hemodynamics for later Fontan procedures.
