Background. In patients with a univentricular arterio-venous connection, tr
ansection of the main pulmonary artery may be performed as part of a bidire
ctional cavo-pulmonary shunt or Fontan procedure. The proximal stump of the
pulmonary artery may remain in the systemic circulation. In cases with a d
iscordant ventriculoarterial connection, subsequent restriction of the bulb
oventricular foramen may lead to subaortic stenosis. The subaortic stenosis
can be corrected in some patients by directing the systemic flow through a
combined nonobstructed aortopulmonary outlet, as in the Damus-Kaye-Stansel
connection. Previous closure of the pulmonary artery has been considered b
y some investigators to be a relative contraindication to the Damus-Kaye-St
ansel procedure, unless an allograft root can be added to the circuit after
excision of the closed pulmonary stump.
Methods. Three patients with previously transected pulmonary arteries under
went a modified Damus-Kaye-Stansel connection using the native pulmonary va
lve and the proximal pulmonary artery stump.
Results. The native pulmonary valves have functioned well despite thrombus
formation in the proximal stump in 2 patients before Damus conversion. All
3 patients are alive and well after 108, 19, and 3 months, with competent n
onobstructed ventriculoarterial connections.
Conclusions. If transection and closure of the pulmonary artery as part of
a previous palliation has spared the pulmonary valve, then the native pulmo
nary outlet might be used for a safe Damus-Kaye-Stansel connection. (C) 199
9 by The Society of Thoracic Surgeons.