How Is It Treated? Damus-Kaye-Stansel Procedure Excessive pulmonary blood flow in double inlet left ventricle may be corrected by the insertion of a band around the trunk of the pulmonary artery shown in yellow on the diagram at right. This narrows the pulmonary artery, which reduces blood flow. There may be complications after the Pulmonary Band Procedure, resulting in obstructions to the flow of blood through the aorta to the body. This situation may be treated by surgery.
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All rights Reserved. However, there have been few reports on which surgical technique shows a better outcome. The objective of this study was to compare the outcome of the DKS procedure according to the surgical technique used.
Methods We retrospectively reviewed 12 consecutive patients who underwent the DKS procedure from March to April When the relationship of the great arteries was anterior-posterior, the double-barrel technique group A was performed. If the relationship was side-by-side, the ascending aortic flap technique group B was performed. Results There was no early mortality and 1 late mortality in group B.
Further, a significant postoperative pressure gradient was not observed in either group A or group B. More than moderate postoperative neoaortic regurgitation was observed in 1 patient of group B; this patient underwent neoaortic valve replacement 66 months after the DKS procedure.
Keywords: Great vessels, Pediatric, Congenital heart disease CHD , Fontan operation INTRODUCTION Patients with a functional single ventricle undergo multiple-stage operations, including postnatal palliations, which restrict or increase pulmonary blood flow according to the amount of the existing pulmonary blood flow, bidirectional cavopulmonary shunt, and finally, the Fontan operation.
However, any functional single ventricle anomalies for example, tricuspid atresia and double inlet left ventricle with rudimentary bulboventricular foramen have the problem of systemic ventricular outflow tract obstruction SVOTO after volume reduction surgery. SVOTO could result in ventricular hypertrophy, impaired diastolic function, and subendocardial ischemia with subsequent deleterious effects on the single ventricle.
Typical approaches to the management of SVOTO include the enlargement of the bulboventricular foramen or the ventricular septal defect, and the resection of the subaortic conus. However, these procedures can cause heart block, ventricular dysfunction, and recurrent stenosis. This operation was first introduced for biventricular repair in patients with dextro-transposition of the great arteries [ 6 — 8 ]. The original DKS procedure was an end-to-side anastomosis between the main pulmonary artery and the ascending aorta.
Since then, there have been numerous articles proposing modified DKS procedures. Waldman et al. Laks et al. We decided upon the DKS operation technique according to the relationship of the aorta and the main pulmonary artery. There have been a few reports about which surgical technique shows better outcomes.
The objective of this study is to compare the outcomes of the DKS procedure according to the surgical technique used from the perspective of neo-aortic regurgitation and recurrent SVOTO, which are considered to be two major complications caused by the DKS procedure [ 12 — 14 ]. Any patients who underwent the Norwood operation were excluded. If the great arteries had the relationship of anterior-posterior, we chose the double-barrel technique group A , and if they lay side-by-side, we performed the ascending aorta flap technique group B , which is a type of end-to-side DKS procedure with patch augmentation [ 12 ].
Thereafter, a bovine pericardium was used for repairing the anterior defect Fig. All DKS operations were performed by a single surgeon.
Indications[ edit ] A Yasui procedure can be done instead of a Norwood operation in some cases of LVOT obstruction to avoid committing a child to a single-ventricle heart, or it can follow a Norwood operation when the surgeon uses a staged approach. It is also used when the Ross procedure or Konno procedure are not feasible in children who have had other surgeries to repair coarctation of the aorta or interrupted aortic arch. If there is a patent ductus arterosus , the surgeon begins by closing it. The surgeon then connects the separated parts of the aorta together.