USEFULNESS OF BANDING OF THE PULMONARY TRUNK WITH SINGLE VENTRICLE PHYSIOLOGY AT RISK FOR SUBAORTIC OBSTRUCTION

This study addresses the effects of early banding of the pulmonary tru nk and subsequent management of subaortic obstruction on the attainmen t of acceptable pre-Fontan hemodynamics in patients with a single left ventricle and aorta arising from an outflow chamber. We report our ex perience with 26 patients seen at our institution between January 1984 and December 1994 with a diagnosis of double-inlet left ventricle or tricuspid atresia and transposed great arteries, who were initially ma naged with pulmonary artery banding in the first 6 months of life. Pul monary artery band placement was performed at an age of 2.1 +/- 1.8 mo nths (mean +/- SD). Associated aortic arch abnormalities were present in 8 patients (31%). There were 19 patients (73%) who underwent treatm ent with a Damus-Kaye-Stansel procedure or ventricular septal defect ( VSD) enlargement for a significant subaortic gradient or morphological ly small VSD, alone or in conjunction with a Glenn or Fontan procedure . Eighteen of 26 patients (69%) underwent cardiac catheterization to a ssess their candidacy for the Fontan operation. Of this group, 16 were classified as low to moderate risk and 2 as high-risk Fontan candidat es, based on hemodynamic criteria. The cumulative mortality for the en tire cohort was 19%, Our results suggest that this high-risk group of patients con undergo effective pulmonary artery banding as an initial palliative step, with subsequent intervention for subaortic obstructio n when it is documented or highly suspected, and that acceptable pre-f ontan hemodynamic parameters can be achieved.