Pulmonary artery banding and subaortic stenosis in patients with single ventricle: surgical alternatives and clinical outcome.

Subaortic obstruction is a potential problem in patients with single ventricle and a subaortic outflow chamber. Previous reports have indicated an association between pulmonary artery banding and the development of subaortic obstruction. The purpose of this study was to determine the incidence of subaortic obstruction in our patients with this cardiac anomaly who have undergone pulmonary artery banding, and to determine the eventual outcome in those who did develop obstruction. By reviewing cardiac catheterizations performed between 1977 and 1985, we found 36 patients with single ventricle and a subaortic outflow chamber. Ten patients had been lost to follow-up or had died within 3 months of banding. Twelve of the remaining 26 patients developed a pressure gradient between the left ventricle and ascending aorta, although 7 of these 12 had minimal gradients. Eight of the 12 have undergone further surgery, with the best results in patients who underwent a combined modified Fontan and Damus-Kaye-Stansel procedure. We believe that although subaortic obstruction may develop in patients with single ventricle after pulmonary artery banding, the degree of obstruction is often minimal, and in more severe cases the obstruction can be alleviated with a Damus-Kaye-Stansel procedure. (Texas Heart Institute Journal 1992; 19:15-20)