Hostname: page-component-586b7cd67f-rcrh6 Total loading time: 0 Render date: 2024-11-23T07:03:16.610Z Has data issue: false hasContentIssue false

The potentially obstructive subaortic region and banding of the pulmonary trunk—selected observations in the patient considered for a Fontan procedure

Published online by Cambridge University Press:  19 August 2008

Robert M. Freedom*
Affiliation:
From the Division of Cardiology, The Hospital for Sick Children, Toronto
Teiji Akagi
Affiliation:
From the Division of Cardiology, The Hospital for Sick Children, Toronto
Leland N. Benson
Affiliation:
From the Division of Cardiology, The Hospital for Sick Children, Toronto
*
Correspondence to Dr. Robert M. Freedom, The Hospital for Sick Children, Division of Cardiology, Room 1503, 555 University Avenue, Toronto, Ontario, CanadaM5G 1X8. Tel. 416-598-6132; Fax. 416-598-7547.
Rights & Permissions [Opens in a new window]

Summary

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

There is a clear and present danger for the patient considered for Fontan's operation in the presence of excessive ventricular hypertrophy and/or mass. Such ventricular hypertrophy and/or mass probably reflects singly, or in combination, banding of the pulmonary trunk and subaortic stenosis, as well as other factors. While one can construct a number of therapeutic algorithms for patients seen at various ages with a restrictive ventricular septal defect and subaortic stenosis in the setting of double inlet left ventricle and discordant ventriculoarterial connections, the optimal management should be to minimize the potential risks for development of subaortic stenosis and excessive ventricular hypertrophy and/or mass.

Type
Editorial Comment
Copyright
Copyright © Cambridge University Press 1993

References

1.Choussat, A, Fontan, F, Besse, P, Vallot, F, Chauve, A, Bricaud, H. Selection criteria for Fontan's procedure. In: Paediatric Cardiology, 1977. Anderson, RH, Shinebourne, EA (eds). Churchill Livingstone, Edinburgh, 1978, pp 559566.Google Scholar
2.Fontan, F, Baudet, E. Surgical repair of tricuspid atresia. Thorax 1971; 26: 240248.CrossRefGoogle ScholarPubMed
3.Caspi, J, Coles, JG, Rabinovitch, M, Cohen, D, Trusler, GA, Williams, WG, Wilson, GJ, Freedom, RM. Morphological findings contributing to a failed Fontan procedure. Circulation 1990; 82(Suppl V): V 177V 182.Google ScholarPubMed
4.Cohen, AJ, Cleveland, DC, Dyck, J, Poppe, D, Smallhorn, JF, Freedom, RM, Trusler, GA, Coles, JG, Moes, CAF, Rebeyka, IM, Williams, WG. Results of the Fontan procedure for patients with univentricular heart. Ann Thorac Surg 1992. [In Press]Google Scholar
5.Ilbawi, MN, DeLeon, SY, Wilson, WR Jr, Quiñones, JA, Roberson, DA, Husayni, TS, Thilenius, OG, Arcilla, RA. Advantages of early relief of subaortic stenosis in single ventricle equivalents. Ann Thorac Surg 1991; 52: 842849.CrossRefGoogle ScholarPubMed
6.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: 10491064.CrossRefGoogle ScholarPubMed
7.Seliem, M, Muster, AJ, Paul, MH, Benson, DW Jr. Relation between preoperative left ventricular muscle mass and outcome of the Fontan procedure in patients with tricuspid atresia. J Am Coll Cardiol 1989; 14: 750755.CrossRefGoogle ScholarPubMed
8.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 saga of evolution and caution. J Am Coll Cardiol 1987; 10: 427429.CrossRefGoogle ScholarPubMed
9.Freedom, RM, Trusler, GA. Arterial switch for palliation of subaortic stenosis in single ventricle and transposition: no mean feat! Ann Thorac Surg 1991; 52: 415416. [Editorial]CrossRefGoogle ScholarPubMed
10.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: 758764.CrossRefGoogle ScholarPubMed
11.Penny, DJ, Lincoln, C, Shore, DF, Xiao, HB, Rigby, ML, Redington, AN. The acute effects of transition to a fontan circulation. Circulation 1991; 84(Suppl III): III 482. [Abstract]Google Scholar
12.Rao, PS. Natural history of the ventricular septal defect in tricuspid atresia and its surgical implications. Br Heart J 1977; 39: 276288.CrossRefGoogle ScholarPubMed
13.Rao, PS. Further observations on the spontaneous closure of physiologically advantageous ventricular septal defects in tricuspid atresia: surgical implications. Ann Thorac Surg 1983; 35: 121131.CrossRefGoogle ScholarPubMed
14.Rao, PS. Subaortic obstruction after pulmonary artery banding in patients with tricuspid atresia and double-inlet left ventricle and ventriculoarterial discordance. J Am Coll Cardiol 1991; 18: 15851586. [Letter]CrossRefGoogle ScholarPubMed
15.Anderson, RH. Problems in nomenclature: bulboventricular foramen versus ventricular septal defect. J Am Coll Cardiol 1988; 11:674675. [Letter]CrossRefGoogle ScholarPubMed
16.Freedom, RM, Culham, JAG, Moes, CAF. Angiocardiography of Congenital Heart Disease. MacMillan Publishing Co., New York, 1984, pp 555574.Google Scholar
17.Bevilacqua, M, Sanders, SP, Van Praagh, S, Colan, SD, Parness, I. Double–inlet single leftventricle:echocardiographic anatomy with emphasis on the morphology of the atrioventricular valves and ventricular septal defect. J Am Coll Cardiol 1991; 18: 559568.CrossRefGoogle Scholar
18.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: 767781.CrossRefGoogle ScholarPubMed
19.Lincoln, C, Anderson, RH. Nomenclatura obscura: subaortic obstruction in double–inlet left ventricle and related lesions. Ann Thorac Surg 1991; 52: 730731.CrossRefGoogle ScholarPubMed
20.Anderson, RH, Penkoske, PA, Zuberbuhler, JR. Variable morphology of ventricular septal defect in double inlet left ventricle. Am J Cardiol 1985; 55: 15601565.CrossRefGoogle ScholarPubMed
21.Freedom, RM. The morphologic and therapeutic implications of an obstructive anomaly of the aortic arch in infants with complex congenital heart disease. In: Parenzan, L, Crupi, GC, Graham, G (eds). Congenital Heart Disease in the First Three Months of Life: Medical and Surgical Aspects. Patron Editore, Bologna, 1981, pp 341361.Google Scholar
22.Freedom, RM, Rowe, RD. Morphological and topographical variations of the outlet chamber in complex congenital heart disease: an angiographic study. Cath Cardiovasc Diagn 1978; 4: 345371.CrossRefGoogle Scholar
23.Matitiau, A, Geva, T, Parness, IA, Spevak, PJ, Sanders, SP. Bulboventricular foramen size in single LV/tricuspid atresia: Relation to aortic outflow tract obstruction. Circulation 1990; 82(Suppl III): III 353. [Abstract]Google Scholar
24.Bullaboy, CA, Harned, HS Jr. Aortic atresia with double inlet left ventricle: rudimentary left-sided right ventricle and ventriculoarterial discordance. Br Heart J 1984; 52: 349351.CrossRefGoogle ScholarPubMed
25.Fragoyannis, SG, Nickerson, D. An unusual congenital heart anomaly: Tricuspid atresia, aortic atresia and juxtaposition of atrial appendages. Am J Cardiol 1960; 678681.CrossRefGoogle ScholarPubMed
26.Franklin, RCG, Spiegelhalter, DJ, Rossi, Filho RI, MacArtney, FJ, Anderson, RH, Rigby, ML, Deanfield, JE. Double–inlet ventricle presenting in infancy. Outcome and potential for definitive repair. J Thorac Cardiovasc Surg 1991; 101: 924934.CrossRefGoogle ScholarPubMed
27.Freedom, RM, Dische, MR, Rowe, RD. Pathologic anatomy of subaortic stenosis and atresia in the first year of life. Am J Cardiol 1977; 39: 10351044.CrossRefGoogle ScholarPubMed
28.MacArtney, FJ, Anderson, RH. Angiocardiography and hemo-dynamics of the univentricular heart with two atrioventricular valves or a common atrioventricular valve. In: Paediatric Cardiology, 1977. Anderson, RH, Shinebourne, EA (eds). Churchill Livingstone, Edinburgh, 1978, pp 345372.Google Scholar
29.Van, Praagh R, Plett, J, Van Praagh, S. Single ventricle. Pathology, embryology, terminology and classification. Herz 1979; 4: 113150.Google Scholar
30.Franklin, RCG, Sullivan, ID, 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: 14551464.CrossRefGoogle ScholarPubMed
31.Shiraishi, H, Silverman, NH. Echocardiographic spectrum of double inlet ventricle: evaluation of the interventricular communication. J Am Coll Cardiol 1990; 15: 14011408.CrossRefGoogle ScholarPubMed
32.Karl, TR, Watterson, KG, Sano, S, Mee, RBB. Operations for subaortic stenosis in univentricular hearts. Ann Thorac Surg 1991; 52:420428.CrossRefGoogle ScholarPubMed
33.Cheung, HC, Lincoln, C, Anderson, RH, Ho, SY, Shinebourne, EA, Pallides, S, Rigby, ML. Options for surgical repair in hearts with univentricular atrioventricular connection and subaortic stenosis. J Thorac Cardiovasc Surg 1991; 100: 672681.CrossRefGoogle Scholar
34.Somerville, J, Becu, L, Ross, D. Common ventricle with acquired subaortic obstruction. Am J Cardiol 1974; 34: 206214.CrossRefGoogle ScholarPubMed
35.Rychik, J, Murdison, KA, Chin, AJ, Norwood, WI. Surgical management of severe aortic outflow obstruction in lesions other than the hypoplastic left heart syndrome: Use of a pulmonary artery to aorta anastomosis. J Am Coll Cardiol 1991; 18: 809816.CrossRefGoogle Scholar
36.Freedom, RM, Sondheimer, H, Dische, R, Rowe, RD. Development of “subaortic stenosis” after pulmonary arterial banding for common ventricle. Am J Cardiol 1977; 39: 7883.CrossRefGoogle ScholarPubMed
37.Trusler, GA, Freedom, RM. Management of subaortic stenosis in the univentricular heart. Ann Thor Surg 1989, 47: 643644.CrossRefGoogle ScholarPubMed
38.Franklin, RCG, Spiegelhalter, DJ, Anderson, RH, Macartney, FJ, Rossi, Filho RI, Douglas, JM, Rigby, ML, Deanfield, JE. Double–inlet ventricle presenting in infancy. I. Survival without definitive repair. J Thorac Cardiovasc Surg 1991; 101: 767776.CrossRefGoogle ScholarPubMed
39.Franklin, RCG, Spiegelhalter, DJ, Anderson, RH, MacArtney, FJ, Rossi, Filho RI, Douglas, JM, Rigby, ML, Deanfield, JE. Double–inlet ventricle presenting in infancy. Results of palliative operations. J Thorac Cardiovasc Surg 1991; 101: 917923.CrossRefGoogle ScholarPubMed
40.Fontan, F, Kirklin, JW, Fernández, G, Costa, F, Naftel, DC, Tritto, F, Blackstone, EH. Outcome after a “perfect” Fontan operation. Circulation 1990; 81: 15201536.CrossRefGoogle ScholarPubMed
41.Fyler, DC.Nadas' Pediatric Cardiology. Hanley & Belfus, Inc., Philadelphia, 1991, pp 649657.Google Scholar
42.Jonas, RA, Giglia, TM, Sanders, SP, Wernovsky, G, Nadal–Ginard, B, Mayer, JE Jr, Castañeda, AR. Rapid, two-stage arterial switch for transposition of the great arteries and intact ventricular septum beyond the neonatal period. Circulation 1989; 80(Suppl I): I 203–I 208.Google ScholarPubMed