ATS
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Ilbawi, M. N.
Right arrow Articles by Arcilla, R. A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Ilbawi, M. N.
Right arrow Articles by Arcilla, R. A.

Ann Thorac Surg 1991;52:842-849
© 1991 The Society of Thoracic Surgeons

Articles

Advantages of early relief of subaortic stenosis in single ventricle equivalents

Michel N. Ilbawi, MD*, Serafin Y. DeLeon, MD, William R. Wilson, Jr, MD, Jose A. Quinones, MD, David A. Roberson, MD, Tarek S. Husayni, MD, Otto G. Thilenius, MD, PhD, Rene A. Arcilla, MD

The Heart Institute for Children, Christ Hospital and Medical Center, Oak Lawn, Illinois USA

Accepted for publication June 20, 1991.

* Address reprint requests to Dr Ilbawi, The Heart Institute for Children, Christ Hospital and Medical Center, 4440 W 95th St, Oak Lawn, IL 60453.


   Abstract
Top
 Abstract
References
 
Thirteen patients with single ventricle equivalents and subaortic stenosis underwent relief of the stenosis and subsequent Fontan operation. Nine patients, group 1, had the obstruction relieved at 3.6 ± 1.6 years of age whenever the pressure gradient became apparent. Four patients, group 2, had the subaortic stenosis operated on at the neonatal period, 10.5 ± 10 days old, before hemodynamic evidence of obstruction. Preoperative pressure gradient across the outflow tract was 44.2 ±4.7 mm Hg in group 1 versus 4.7 ± 5 mm Hg in group 2 (p = 0.002). Ventricular muscle mass was 186% ± 18% in group 1 versus 114% ± 5% of normal in group 2 (p = 0.0001), and mass/volume ratio was 1.12 ± 0.62 in group 1 versus 0.62 ± 0.16 in group 2 (p = 0.003). Relief of subaortic stenosis was achieved by proximal pulmonary artery to ascending aorta or aortic arch anastomosis and by systemic to distal pulmonary artery shunt. There was no hospital mortality or complication related to the procedure. At evaluation before Fontan operation, 4.3 ±1.6 years after relief of subaortic stenosis in group 1 and 3.2 ± 0.9 years in group 2, the pressure gradient across the ventricular outflow tract was 4 ± 3 mm Hg in group 1 versus 3 ± 2 mm Hg in group 2 (p = not significant), ventricular muscle mass was 184% ± 31% in group 1 versus 114% ± 5% of normal in group 2(p = 0.003), and the mass/volume ratio was 1.17 ± 0.2 in group 1 versus 0.62 ± 0.2 in group 2 (p = 0.003). After Fontan operation, there were two perioperative deaths and two takedowns of Fontan operation in group 1. Postoperative mean right atrial pressure was 17.6 ± 2.1 mm Hg in group 1 versus 11.3 ± 1.7 mm Hg in group 2 (p = 0.01). Serious postoperative effusions were present in 4 of 5 patients (80%) in group 1 versus 0 of 4 patients (0%) in group 2. Data suggest that early relief of subaortic stenosis in single ventricle equivalents using the modified techniques described optimizes ventricular compliance, protects the pulmonary vascular bed, and improves the outcome after Fontan operation.


   References
Top
 Abstract
 References
 

  1. Coles JG, Kielmanowica S, Freedom RM, et al. Surgical experience with the modified Fontan procedure Circulation 1987;76(Suppl 3):61-66.
  2. Tchervenkov CI, Beland MJ, Latter DA, Dobell ARC. Norwood operation for univentricular heart with subaortic stenosis in the neonate Ann Thorac Surg 1990;50:822-825.[Abstract/Free Full Text]
  3. Shiraishi H, Silverman NH. Echocardiographic spectrum of double inlet ventricle: evaluation of the interventricular communication J Am Coll Cardiol 1990;15:1401-1408.[Medline]
  4. Barber G, Hagler DJ, Edwards WD, et al. Surgical repair of univentricular heart (double inlet left ventricle) with obstructed anterior subaortic outlet chamber J Am Coll Cardiol 1987;4:771-778.
  5. Rothman A, Lang P, Lock JE, Jonas RA, Mayer JE, Castaneda AR. Surgical management of subaortic obstruction in single left ventricle and tricuspid atresia J Am Coll Cardiol 1987;10:421-426.[Medline]
  6. Freedom RM. The dinosaur and banding of the main pulmonary trunk in the heart with functionally one ventricle and transposition of the great arteries: a sage of evolution and caution J Am Coll Cardiol 1987;10:427-429.[Medline]
  7. Penkoske PA, Freedom RM, Williams WG, Trusler GA, Rowe RD. Surgical palliation of subaortic stenosis in the univentricular heart J Thorac Cardiovasc Surg 1984;87:767-781.[Abstract]
  8. Di Donato R, Di Carlo DC, Giannico S, Marcelletti C. Palliation of complex cardiac anomalies with subaortic obstruction: new operative approach J Am Coll Cardiol 1989;13:406-412.[Medline]
  9. Soto B, Pacifico AD, DiSciascio G. Univentricular heart: an angiographic study Am J Cardiol 1982;49:787-794.[Medline]
  10. Shimazaki Y, Kawashima Y, Mori T, Kitamura S, Matsuda H, Yokota K. Ventricular volume characteristics of single ventricle before corrective surgery Am J Cardiol 1980;45:806.[Medline]
  11. Huhta JC, Seward JB, Tajik AJ, Hagler DJ, Edwards WD. Two-dimensional echocardiographic spectrum of univentricular atrioventricular connection J Am Coll Cardiol 1985;5:149-157.[Medline]
  12. Onnasch DGW, Lange PE, Heintzen PH. Left ventricular muscle volume in children and young adults Pediatr Cardiol 1984;5:101-106.[Medline]
  13. Rackley CH, Dodge HT, Coble Jr YD, Hay RE. A method of determining left ventricular mass in man Circulation 1964;29:666.[Abstract/Free Full Text]
  14. Daniels SR, Meyer RA, Liang Y, Bove KE. Echocardiographically determined left ventricular mass index in normal children, adolescents and young adults J Am Coll Cardiol 1988;12:703-708.[Medline]
  15. Franklin RCG, Sullivan ID, Anderson RH, Shinebourne EA, Deanfield JE. Is banding of the pulmonary trunk obsolete for infants with tricuspid atresia and double inlet ventricle with a discordant ventriculoarterial connection? Role of aortic arch obstruction and subaortic stenosis J Am Coll Cardiol 1990;16:1455-1464.[Medline]
  16. 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.[Abstract/Free Full Text]
  17. Trusler GA, Freedom RM. Management of subaortic stenosis in the univentricular heart Ann Thorac Surg 1989;47:643-644.[Free Full Text]
  18. Freedom RM, Sondheimer H, Dische R, Rowe RD. Development of "subaortic stenosis" after pulmonary arterial banding for common ventricle Am J Cardiol 1977;39:78-83.[Medline]
  19. Jonas RA, Castaneda AR, Lang P. Single ventricle (single- or double-inlet) complicated by subaortic stenosis: surgical options in infancy Ann Thorac Surg 1985;39:361.[Abstract/Free Full Text]
  20. Pantley G, Morton M, Rahimtoola SH. Effects of successful, uncomplicated valve replacement on ventricular hypertrophy, volume and performance in aortic stenosis and in aortic incompetence J Thorac Cardiovasc Surg 1978;75:383-391.[Medline]
  21. Cheung HC, Lincoln C, Anderson RH, et al. Options for surgical repair in hearts with univentricular atrioventricular connection and subaortic stenosis J Thorac Cardiovasc Surg 1990;100:672-681.[Abstract]
  22. Newfeld EA, Nikaidoh H. Surgical management of subaortic stenosis in patients with single ventricle and transposition of the great vessels Circulation 1987;76(Suppl 3):29-33.
  23. Juaneda E, Haworth SG. Pulmonary vascular structure in patients dying after a Fontan procedure. The lung as a risk factor Br Heart J 1984;52:575-580.[Abstract/Free Full Text]
  24. Kirklin JK, Blackstone EH, Kirklin JW, Pacifico AD, Bargeron LM. The Fontan operation: ventricular hypertrophy, age, and date of operation as risk factors J Thorac Cardiovasc Surg 1986;92:1049.[Abstract]
  25. Anderson RH, Penkoske PA, Zuberbuhler JR. Variable morphology of ventricular septal defect in double inlet left ventricle Am J Cardiol 1985;55:1560-1565.[Medline]
  26. Waldman JD, Lamberti JJ, George L, et al. Experience with Damus procedure Circulation 1988;78(Suppl 3):32-39.



This article has been cited by other articles:


Home page
 Ann. Thorac. Surg.Home page
N. Kajihara, T. Asou, Y. Takeda, Y. Kosaka, Y. Onakatomi, H. Nagafuchi, and S. Yasui
Pulmonary Artery Banding for Functionally Single Ventricles: Impact of Tighter Banding in Staged Fontan Era
Ann. Thorac. Surg., January 1, 2010; 89(1): 174 - 179.
[Abstract] [Full Text] [PDF]

Home page
 Eur J Cardiothorac SurgHome page
M. D. Rodefeld, M. Ruzmetov, M. S. Schamberger, D. A. Girod, M. W. Turrentine, and J. W. Brown
Staged surgical repair of functional single ventricle in infants with unobstructed pulmonary blood flow
Eur J Cardiothorac Surg, June 1, 2005; 27(6): 949 - 955.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
S. M. Bradley, J. M. Simsic, A. M. Atz, and B. H. Dorman
The infant with single ventricle and excessive pulmonary blood flow: results of a strategy of pulmonary artery division and shunt
Ann. Thorac. Surg., September 1, 2002; 74(3): 805 - 810.
[Abstract] [Full Text] [PDF]

Home page
 Eur J Cardiothorac SurgHome page
C. I. Tchervenkov, D. Shum-Tim, M. J. Beland, L. Jutras, and R. Platt
Single ventricle with systemic obstruction in early life: comparison of initial pulmonary artery banding versus the Norwood operation
Eur J Cardiothorac Surg, May 1, 2001; 19(5): 671 - 677.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
M. Jahangiri, E. A. Shinebourne, D. B. Ross, R. H. Anderson, and C. Lincoln
Long-term results of relief of subaortic stenosis in univentricular atrioventricular connection with discordant ventriculoarterial connections
Ann. Thorac. Surg., March 1, 2001; 71(3): 907 - 910.
[Abstract] [Full Text] [PDF]

Home page
 Eur J Cardiothorac SurgHome page
W. Daenen, B. Eyskens, B. Meyns, and M. Gewillig
Neonatal pulmonary artery banding does not compromise the short-term function of a Damus-Kaye-Stansel connection
Eur J Cardiothorac Surg, June 1, 2000; 17(6): 655 - 657.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
R. M. Freedom
Subaortic obstruction and the fontan operation
Ann. Thorac. Surg., August 1, 1998; 66(2): 649 - 652.
[Abstract] [Full Text] [PDF]

Home page
 Asian Cardiovascular and Thoracic AnnalsHome page
J. A. van Son, V. Falk, and F. W. Mohr
Instantaneous Subaortic Obstruction after Closure of Aortopulmonary Shunt
Asian Cardiovascular and Thoracic Annals, March 1, 1997; 5(1): 59 - 61.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
D. A. Vitullo, S. Y. DeLeon, T. E. Berry, J. J. Bonilla, S. V. Chhangani, F. Cetta, J. A. Quinones, T. J. Bell, and E. A. Fisher
Clinical Improvement After Revision in Fontan Patients
Ann. Thorac. Surg., June 1, 1996; 61(6): 1797 - 1804.
[Abstract] [Full Text]

Home page
 Ann. Thorac. Surg.Home page
V. P. Podzolkov, S. B. Zaetz, B. G. Alekyan, M. R. Chiaureli, I. A. Yurlov, and I. G. Chernikh
Surgical reinterventions after modified Fontan operations
Ann. Thorac. Surg., December 1, 1995; 60(suppl_3): S572 - S577.
[Abstract] [PDF]

Home page
 Ann. Thorac. Surg.Home page
A. Serraf, S. Conte, F. Lacour-Gayet, J. Bruniaux, M. Sousa-Uva, R. Roussin, and C. Planche
Systemic obstruction in univentricular hearts: Surgical options for neonates
Ann. Thorac. Surg., October 1, 1995; 60(4): 970 - 977.
[Abstract] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
J. A. M. van Son, V. M. Reddy, G. S. Haas, and F. L. Hanley
MODIFIED SURGICAL TECHNIQUES FOR RELIEF OF AORTIC OBSTRUCTION IN {S,L,L} HEARTS WITH RUDIMENTARY RIGHT VENTRICLE AND RESTRICTIVE BULBOVENTRICULAR FORAMEN
J. Thorac. Cardiovasc. Surg., October 1, 1995; 110(4): 909 - 915.
[Abstract] [Full Text]

Home page
 Ann. Thorac. Surg.Home page
S. Y. DeLeon, J. E. Freeman, E. P. Ow, J. A. Quinones, T. J. Bell, E. A. Fisher, F. X. Downey, H. J. Sullivan, and R. Pifarre
Obligatory Glenn shunt in fenestrated fontan
Ann. Thorac. Surg., September 1, 1993; 56(3): 510 - 514.
[Abstract] [PDF]

Home page
 Ann. Thorac. Surg.Home page
R. N. Gates, H. Laks, A. Elami, D. C. Drinkwater Jr, J. M. Pearl, B. L. George, J. M. Jarmakani, and R. G. Williams
Damus-Stansel-Kaye procedure: Current indications and results
Ann. Thorac. Surg., July 1, 1993; 56(1): 111 - 119.
[Abstract] [PDF]

Home page
 Ann. Thorac. Surg.Home page
C. B. Huddleston, C. E. Canter, and T. L. Spray
Damus-Kaye-Stansel with cavopulmonary connection for single ventricle and subaortic obstruction
Ann. Thorac. Surg., February 1, 1993; 55(2): 339 - 346.
[Abstract] [PDF]

Home page
 Ann. Thorac. Surg.Home page
H. Laks, R. N. Gates, A. Elami, and J. M. Pearl
Damus-Stansel-Kaye procedure: Technical modifications
Ann. Thorac. Surg., July 1, 1992; 54(1): 169 - 172.
[Abstract] [PDF]

Home page
 Ann. Thorac. Surg.Home page
C. Lincoln and R. H. Anderson
Nomenclatura obscura: Subaortic obstruction in double-inlet left ventricle and related lesions
Ann. Thorac. Surg., October 1, 1991; 52(4): 730 - 731.
[PDF]

This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Ilbawi, M. N.
Right arrow Articles by Arcilla, R. A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Ilbawi, M. N.
Right arrow Articles by Arcilla, R. A.