Management of univentricular heart with systemic ventricular outflow obstruction by pulmonary artery banding and Damus-Kaye-Stansel operation

Miura, Takuya; Kishimoto, Hiroyuki; Kawata, Hiroaki; Hata, Masatoshi; Hoashi, Takaya; Nakajima, Tohru

doi:10.1016/s0003-4975(03)01248-7

Cited by 24 publications

(13 citation statements)

References 20 publications

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“…Trusler's rule is often followed in such patients. [2] According to Trusler, the PA band circumference in patients with noncyanotic nonmixing lesions (e.g., ventricular septal defects [VSD]) is 20 mm+1 mm/kg body weight. For patients with mixing lesions (e.g., transposition of great arteries with VSD), the formula is 24 mm+1 mm/kg body weight.…”

Section: Discussionmentioning

confidence: 99%

ST segment depression following pulmonary artery banding

et al. 2012

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epinephrine 0.04 µg/kg/min to 0.08 µg/kg/min) and adequate filling. The coronary arteries were inspected by the surgeon to rule out any pressure by the band. Such an occurrence was possible because the great vessels were lying side by side. The ST Segment changes persisted into the postoperative period despite nitroglycerine infusion at 0.5 µg/kg/min and relatively normal arterial oxygen saturations [ Table 1]. After 48 hours, the ST changes subsided without any further intervention.The second case was also a month old baby weighing 2.9 kg, with multiple muscular and inlet VSD with an outlet extension. There was mild hypoplasia of the left atrium and LV. A small Patent Foramen Ovale (PFO) was present. The prebanding saturation was 100%. The banding perimeter was 22 mm at a 0.5 FiO 2 . The PA pressure was 40/17 mmHg with systemic pressures of 80/34 mmHg and systemic oxygen saturations of 82% in the period immediate after banding.In this case too, ST depression of −3 mm was noted without any hemodynamic instability. However, after 10 minutes, tachycardia and worsening of ST depression to −7 mm warranted a loosening of the band to 23 mm. The ST depression reduced to −3 mm in the leads II, III, and AVF but remained at that level despite our attempts to increase the aortic diastolic pressures with blood transfusion and increasing the ionotropic support (epinephrine from 0.02 µg/kg/min to 0.04 µ/kg/min). Similar to the previous case, coronary artery compression by the band was ruled out. The ST depression in this case persisted till the second postoperative day Pulmonary artery banding (PAB) is a useful palliative procedure for a diverse group of patients with congenital cardiac anomalies and unrestricted pulmonary blood flow. With improved results following primary repair of intracardiac anomalies in neonates and infants, PAB is reserved for severely ill patients with complex lesions not amenable to early definitive correction. Currently, PAB is indicated in patients with excessive pulmonary blood flow (PBF) associated with single ventricle (SV) or biventricular physiology. [1] Children undergoing PAB have a stormy postoperative period secondary to sudden alterations in their existing physiology. We noted two neonates who had ST segment changes in the perioperative period, for which we did not have an explanation.The first case is of a month-old baby weighing 2.5 kg diagnosed to have hypoplastic left ventricle (LV), atretic mitral valve, transposed, side by side great arteries, and the SV of right ventricle morphology. There was torrential PBF through an unrestrictive bulboventricular foramen. The baby was taken up for elective atrial septectomy and PAB. The prebanding saturation was 96%. Banding perimeter was 25 mm with a band gradient of 20 mmHg at inspired oxygen fraction of 0.5. Pulmonary artery (PA) pressures were 40/20 mmHg with the systemic pressures of 60/20 mmHg. The patient maintained a saturation of 85% postbanding. Soon after the PA band was tightened, we noticed the appearance of ST depression in the all ...

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Section: Discussionmentioning

confidence: 99%

ST segment depression following pulmonary artery banding

et al. 2012

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“…The majority of patients with a single functioning ventricle are adequately treated with a modified Fontan procedure (with the exception of patients with a hypoplastic left heart, who are treated with the Norwood procedure) (86). However, the presence of systemic outflow obstruction in these patients is one of the most important factors affecting long-term outcome.…”

Section: Dks Proceduresmentioning

confidence: 99%

Repair of Congenital Heart Disease: A Primer–Part 1

Gaca¹,

Jaggers²,

Dudley³

et al. 2008

Radiology

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Advances in the surgical management of congenital heart disease have led to enhanced patient survival and quality of life. Improvements in technology in computed tomography and magnetic resonance imaging have resulted in increasing use of cross-sectional imaging in these patients. Perioperative care in these patients requires that radiologists have an understanding of the surgical treatment and the resultant postoperative anatomy. Because many of these patients with treated congenital heart disease are being followed into the 4th and 5th decades of life, this is information that will fall within the domain of the radiologist who deals with adults. This review, which is presented in two parts, covers the major surgical procedures used for the treatment of congenital heart disease, and will be presented in two parts. In part 1, median sternotomy and its complications, palliative procedures, and complex repairs are discussed.

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“…In those patients without a resting or basal pressure gradient, Somerville et al 65 suggested 30 years ago using isoprenaline provocation, a manoeuvre which we also have used to unmask latent subaortic stenosis. 36,37 In more recent times, Miura et al 66 have provided an area of the ventricular septal defect indexed to normal diameters of the aortic valve, the latter derived from an equation calculated by body surface area. Others have indexed the echocardiographically-derived area of the defect to body surface area.…”

Section: When Can the Ventricular Septal Defect Be Considered Restricmentioning

confidence: 99%

“…63 In one such study, Shiraishi et al 63 confirmed that the smaller defects were associated with an obstructive anomaly of the aortic arch. Miura et al 66 have found that a pressure gradient of more than 10 millimetres of mercury is demonstrated between ventricle and aorta when the percentage of the indexed ventricular outflow tract was below 60%.…”

Section: When Can the Ventricular Septal Defect Be Considered Restricmentioning

confidence: 99%

Designing therapeutic strategies for patients with a dominant left ventricle, discordant ventriculo-arterial connections, and unobstructed flow of blood to the lungs

et al. 2004

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The palliation of the cyanotic child with a dominant morphologically left ventricle, discordant ventriculo-arterial connections, and obstruction to the pulmonary outflow tract has continued to evolve and mature. The evolution began in the early days of surgical palliation with the Blalock-Taussig shunt, extended to construction of cavopulmonary shunts, if required, and then to the Fontan procedure and its subsequent modifications. This journey took nearly 30 years to complete. There is increasing clinical data to document the beneficial effects of this approach, with ever-improving outcomes. Some aspects of the history of the cavopulmonary shunt have been previously reviewed in this journal and elsewhere, as have analysis of outcomes for some groups of patients considered for surgical completion of the Fontan circulation. While there has been some ongoing interest in ventricular septation since the early success of Sakakibara et al., this approach has largely been abandoned. Considerably more challenges and debate resonate in the surgical algorithms defined for patients whose hearts are characterized by a dominant left ventricle, discordant ventriculo-arterial connections, and unobstructed flow of blood to the lungs. This latter group will be the focus of this review, as will the aetiology of the myocardial hypertrophy that is particularly frequent in this group of patients, its clinical recognition, indeed its anticipation, and the multiple surgical strategies designed to prevent or treat it. All these manoeuvres are considered to optimise suitability for, and outcome from, creation of the Fontan circulation.

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Management of univentricular heart with systemic ventricular outflow obstruction by pulmonary artery banding and Damus-Kaye-Stansel operation

Cited by 24 publications

References 20 publications

ST segment depression following pulmonary artery banding

ST segment depression following pulmonary artery banding

Repair of Congenital Heart Disease: A Primer–Part 1

Designing therapeutic strategies for patients with a dominant left ventricle, discordant ventriculo-arterial connections, and unobstructed flow of blood to the lungs

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