[Appropriate early open heart palliation of univentricular atrioventricular connection with subaortic stenosis]

Long-term conventional pulmonary artery banding deteriorates ventricular function in patients who have univentricular atrioventricular connection with subaortic obstruction. Protection of the pulmonary vascular bed and early relief of subaortic stenosis is essential to improve the outcome after Fontan operation. From January 1995 through January 1996, three infants underwent open heart palliation because of univentricular atrioventricular connection with subaortic stenosis. All infants had discordant ventriculoarterial connection. One infant underwent the Norwood procedure (patient 1). Two infants underwent palliative arterial switch operation, one with repair of aortic arch and a Blalock-Taussig shunt (patient 2) and the other with endoluminal pulmonary artery banding (patient 3). Patient 3 required a subsequent conventional pulmonary arterial banding. The postoperative recovery period were smooth in the all infants. All infants kept sufficient PO2 ranging from 34 to 37 mmHg postoperatively. On follow-up after 16 months pulmonary artery index decreased in patient 1. On the other hand, angiogram demonstrated satisfactory pulmonary arterial growth in patient 2. There were two late death, occurring in patient 1 (sudden death) and patient 3 (pneumonia). Patient 2 awaits a Fontan type procedure. It is difficult to adjust appropriate blood flow through a Blalock-Taussing shunt and a surgically isolated pulmonary artery is capable of inducing pulmonary distortion after Damus-Norwoood type operation. Whereas natural regulation of the pulmonary arterial blood flow by a restrictive ventricular outflow tract is come up after a palliative arterial switch operation. Palliative arterial switch operation is an useful alternative open heart palliation for neonates and early infants who had univentricular atrioventricular connection with subaortic stenosis.