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Ann Thorac Surg 1995;60:976-977
© 1995 The Society of Thoracic Surgeons

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Discussion

Discussion

The first 20% of the full text of this article appears below.

See also page 970.

DR JOHN E. MAYER, JR (Boston, MA): I enjoyed this paper very much, and I thought it was exceedingly well presented. I believe the conclusions that the authors have reached on the basis of their experience are correct, and my colleagues and I would certainly agree with them that for patients with single ventricle and obstruction to systemic blood flow, the best time to relieve the intracardiac obstruction is in the newborn period. In reviewing a similar group of patients from our institution who all had single left ventricles, we drew almost identical conclusions. It is clear, we think, that an approach of bypassing the subaortic obstruction with either a pulmonary artery--aortic anastomosis or a palliative arterial switch is the approach to be taken.

In the more global sense, I think it is critical that when comparing various surgical management plans for patients with single ventricle, we look at long-term outcome, not just at whether or not the patient survived a neonatal hospitalization. As Dr Serraf has clearly pointed out, the important thing is what happens to the patients down the road, how many of them get to a Fontan procedure and how many of them survive that procedure. Much of that determination is going to depend on the quality of care and the approach during the neonatal period.

I think the last great challenge, if you will, in congenital heart surgery is managing patients with single ventricle. The results from our institution and other centers have a long . . . [Full Text of this Article]

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Systemic Obstruction in Univentricular Hearts: Surgical Options for Neonates

Alain Serraf, Stefano Conte, François Lacour-Gayet, Jacqueline Bruniaux, Miguel Sousa-Uva, Régine Roussin, and Claude Planché
Ann. Thorac. Surg. 1995 60: 970-976. [Abstract] [Full Text]