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Editorial comment

Early pulmonary artery debanding with Damus–Kaye–Stansel procedure provides good haemodynamics for the Fontan circulation

Department of Cardiac Surgery, Birmingham Childrens Hospital, Steelhouse Lane, Birmingham, B4 6NH, United Kingdom

^_* Corresponding author. Tel.: +44 121 333 9435; fax: +44 121 333 9441. (Email: william.brawn@bch.nhs.uk).

Key Words: Pulmonary artery band • Univentricular heart • Fontan procedure • Damus–Kaye–Stansel procedure • Subaortic obstruction

The first 20% of the full text of this article appears below.

The current aim of surgery for patients with univentricular hearts is to provide a non-volume loaded non-hypertrophic ventricular mass, an unobstructed systemic outflow tract, good sized pulmonary arteries with low pulmonary vascular resistance and no atrioventricular valve or semi lunar valve regurgitation or stenosis. In these circumstances the patient is set up for the best possible haemodynamics for the complex palliation of the Fontan procedure. In patients with a univentricular heart and subaortic obstruction or potential obstruction and a ventricular septal defect associated with the rudimentary subaortic outflow chamber, there is often aortic arch hypoplasia with coarctation or even interruption of the aortic arch. In the presence of unrestrictive pulmonary blood flow there is a danger of volume and pressure loading of the heart. This can either cause early death or unsatisfactory haemodynamics for a future Fontan procedure. The aortic . . . [Full Text of this Article]