Mid-Term results for double inlet left ventricle and similar morphologies: timing of Damus-Kaye-Stansel

• Published in: The Annals of thoracic surgery Vol. 78; no. 2; pp. 650 - 657
• Main Authors: Clarke, Andrew J.B, Kasahara, Shingo, Andrews, David R, Cooper, Stephen G, Nicholson, Ian A, Chard, Richard B, Nunn, Graham R, Winlaw, David S
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01-08-2004
• Subjects: Aorta, Thoracic - surgery; Aortic Coarctation - surgery; Cardiac Surgical Procedures - methods; Cardiac Surgical Procedures - statistics & numerical data; Cohort Studies; Follow-Up Studies; Fontan Procedure; Heart Ventricles - abnormalities; Heart Ventricles - surgery; Humans; Ligation; Palliative Care; Postoperative Complications - etiology; Postoperative Complications - mortality; Pulmonary Artery - surgery; Retrospective Studies; Surgical Flaps; Time Factors; Treatment Outcome; Tricuspid Atresia - surgery; Ventricular Outflow Obstruction - etiology; 21
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2004.03.005

Patients with double inlet left ventricle/l-transposition and similar morphologies have their systemic outflow traverse a bulboventricular foramen (BVF), which has a propensity to narrow over time. A Norwood procedure may be performed as the initial palliation. We prefer aortic arch repair and pulmonary artery banding, delaying Damus-Kaye-Stansel (DKS) or BVF resection until the second palliation. The aims of this study were to compare our results with those reported for Norwood strategy and examine the development of systemic outflow obstruction.
Retrospective study of patients with double inlet left ventricle, L-TGA or similar morphology presenting between 1990 and 2000. Follow-up with clinical assessment, echocardiography and catheter studies.
Twenty-five patients had initial palliation with pulmonary artery banding with repair of any associated arch obstruction. Twelve patients had DKS performed as part of their second stage procedure, and 3 had DKS performed later for recurrent stenosis after prior enlargement of BVF. Six patients had BVF resection without later restenosis and 4 patients did not develop BVF stenosis. There was one early death (4%) and two late (8%). Fontan completion was achieved in 20 of the 22 survivors. There were no cases of DKS obstruction, no pulmonary valve had more than mild regurgitation.
Our approach achieves low operative mortality and morbidity and compares favorably with reported results for Norwood palliation. The significant rate of systemic outflow obstruction in those who did not undergo DKS at the second stage confirms the utility of early DKS in children with this morphology.