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Modified Damus-Kaye-Stansel Connection for Systemic Outflow Tract Obstruction After Fontan Operation
Lok Sinha1, Katherine Klein2, Karthik Ramakrishnan1,3
1Department of Cardiovascular Surgery, Children's National Health System, Washington, DC, USA.
World Journal for Pediatric & Congenital Heart Surgery
|February 26, 2020
Summary
Late systemic outflow tract obstruction after Fontan palliation is rare and challenging. A modified Damus-Kaye-Stansel connection using a valved conduit offers a novel solution for adult patients.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Fontan palliation is a surgical procedure for complex single-ventricle congenital heart defects.
- Late systemic outflow tract obstruction is a rare but serious complication following Fontan completion.
- Conventional surgical options are limited due to anatomical changes like pulmonary valve and trunk absence.
Observation:
- A 37-year-old female, palliated in adulthood, developed late systemic outflow tract obstruction post-Fontan.
- The patient's anatomy precluded a standard Damus-Kaye-Stansel connection.
Findings:
- A modified Damus-Kaye-Stansel connection was successfully created using a valved conduit.
- The conduit was placed between the native pulmonary annulus and the ascending aorta.
Implications:
- This modified approach provides a viable treatment strategy for late systemic outflow tract obstruction in adult Fontan patients.
- It highlights the adaptability of surgical techniques for complex congenital heart disease management.
- Offers hope for improved outcomes in previously untreatable cases.
