OUTCOME OF THE 3 PRINCIPAL PALLIATIVE SUR GICAL-PROCEDURES IN PATIENTS WITH A SINGLE VENTRICLE

In emergency cases of babies with a single ventricle and an obstructio n to aortic outflow, low pulmonary flow or, on the contrary, high pulm onary flow, only palliative surgical procedures can be proposed. The a uthors set out to determine the prognosis of a population with this ty pe of lesion having undergone one of the three following procedures : systemic pulmonary shunt, pulmonary artery banding, repair of the aort ic arch (usually associated with pulmonary banding). One hundred and n ineteen (63 %) of the 185 patients hospitalised between 1/01/1970 and 31/12/1991 in the paediatric cardiology unit of the Cardiac Hospital o f Lyon with a diagnosis of single ventricle, underwent one of these th ree procedures as a treatment of first intention. The survival of the 22 patients who underwent pulmonary artery banding (90 +/- 6 %, 85 +/- 8 %, 85 +/- 8 % at 1,5 and 10 years respectively) was significantly b etter than that of the patients undergoing systemico-pulmonary shunt ( 63 +/- 6 %, 53 +/- 6 % and 49 +/- 6 % at 1,5 and 10 years respectively ). On the other hand, repair of an obstacle of the aortic arch was a p recarious procedure as the survival was only 23 +/- 11 %, 16 +/- 11 % and 16 11 % at 1,5 and 10 years respectively). These results suggest, with the reserve inherent to the methodology of retrospective studies of small populations, that it is not illogical to continue to propose pulmonary artery banding for babies with single ventricle associated w ith high pulmonary flow. This procedure should only be envisaged after strict selection of candidates and providing there are facilities for intensive postoperative care. On the other hand, the disappointing re sults of the association of pulmonary banding - aortic arch repair sho uld incite other surgical solutions to the problem of single ventricle with an obstacle to aortic outflow.