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.

Abstract

Subaortic stenosis is well known to complicate the clinical course of patients with single ventricle or univentricular hearts, and we have previously suggested that the development of subaortic stenosis in such patients may be causal to and/or accelerated by previous banding of the main pulmonary trunk. To further define the relationship between banding of the pulmonary artery in patients with univentricular hearts and the development of subaortic stenosis, we examined the morphologic substrate and timing of the development of subaortic stenosis in 43 patients seen at our institution from January 1, 1970, through June 30, 1985. These 43 patients include all patients in this period with an unequivocal univentricular heart whose longitudinal data was available for follow-up. We excluded patients who died within 1 week of surgery, patients lost to follow-up, and patients with evidence of subaortic stenosis before banding. Thirty-one of 43 patients (72. 1 %) developed subaortic stenosis subsequent to banding of the main pulmonary artery. The mean age at banding of those patients who developed subaortic stenosis was 0.21 years, and subaortic stenosis was recognized at a mean age of 2.52 years. For the specific cohort of patients whose ventricular morphology was a main chamber of left ventricular type supporting the pulmonary artery and a rudimentary right ventricle supporting the transposed aorta (32 patients), 27 developed subaortic stenosis (84.4%). Subaortic stenosis in the classic form of single ventricle usually results from progressive restriction of a wholly muscular interventricular communication. Banding of the pulmonary artery by producing myocardial hypertrophy undoubtedly accelerates the potential for subaortic stenosis in these patients. Furthermore, one must realize that subaortic stenosis may be present in the absence of a resting pressure gradient, and such subaortic stenosis can usually be unmasked by stimulation with isoprenaline. Finally, one must be guarded in advocating banding of the pulmonary artery in patients with single ventricle, realizing that subaortic stenosis strongly influences the outcome of more definitive surgery in these patients. Circulation 73, No. 4, 758-764, 1986. THE NATURAL HISTORY of patients with single ventricle (one-ventricle hearts, univentricular hearts, univentricular atrioventricular connection) has been irrevocably altered by those diverse surgical procedures that (1) augment pulmonary blood flow, (2) reduce pulmonary blood flow, (3) augment atrial mixing when intracardiac streaming is disadvantageous, or (4)

Management strategies for interrupted aortic arch with associated anomalies

“…This strategy can maintain acceptable anatomy and haemodynamics for later bidirectional Glenn and Fontan procedures [67,68]. However, PAB is implicated in the accelerated development of subaortic obstruction that ultimately jeopardised Fontan candidacy [67][68][69][70][71][72][73][74][75][76]. Other complications associated with a poorly positioned band or migrations are reported, including branch pulmonary stenoses, semilunar valve insufficiency, and erosion with aneurysm formation [67,69].…”

Outcome of the Norwood procedure in the setting of transposition of the great arteries and functional single left ventricle☆

“…Subsequent progression to a Fontan circulation is associated with a low postoperative mortality and good long-term clinical outcome. Importantly, none of the patients suffered postoperative heart block or needed reoperations for intracardiac obstruc- tions which have previously been highlighted as potential risks in this group of patients [2,9,10] In patients with TGA and a single left ventricle, the VSD is at risk of becoming restrictive. This may happen due to a natural tendency for this particular type of muscular VSD to become smaller, as supported by Rao [9].…”

“…Progression to a restrictive VSD may also be accelerated by surgical palliation: pulmonary artery banding may lead to myocardial hypertrophy and hence VSD restriction with subaortic obstruction [2,10]. Freedom et al reported in patients with single ventricle physiology and TGA initially palliated with pulmonary artery band a high incidence (84.4%) of developing subaortic obstruction [10].…”

“…Patients without any evidence of subaortic obstruction can be simply managed with a pulmonary artery (PA) band with or without arch repair as required [4][5][6][7][8]. However, even with the arch repaired, the risk of a PA band alone in these patients is the progressive development of subaortic obstruction in the future with an unpredictable time course [9][10][11][12].…”

Evolution of restricted bulboventricular foramen in double inlet left ventricle and ventriculoarterial discordance

“…Pulmoner hipertansiyon ile birlikte koarktasyon veya kesintili arkus aorta sıklıkla eşlik eder. İki ventrikül arasındaki ilişkiyi sağlayan bulboventrikü-ler foramenin daralması ve subaortik obstrüksiyon gelişimi sık görülen komplikasyondur (1). Bu çalışmada Mart 2007 ile Mart 2010 arasında hastanemizde çift girişli sol ventrikül (DILV) ve ventriküloarteriyel diskordans tanısı alan hastalarımızı bulboventriküler foramende (BVF) restriksiyon gelişimi açısından değerlendirerek, tanı anında bu klinik seyri öngörebilecek değiş-kenleri incelemeyi amaçladık.…”