Circulation, Vol 73, 758-764, Copyright © 1986 by American Heart Association
RM Freedom, LN Benson, JF Smallhorn, WG Williams, GA Trusler and RD Rowe
Subaortic stenosis is well known to complicate the clinical course of
patients with single ventricle or univentricular hearts, and we have
previously suggested that the development of subaortic stenosis in such
patients may be causal to and/or accelerated by previous banding of the
main pulmonary trunk. To further define the relationship between banding of
the pulmonary artery in patients with univentricular hearts and the
development of subaortic stenosis, we examined the morphologic substrate
and timing of the development of subaortic stenosis in 43 patients seen at
our institution from January 1, 1970, through June 30, 1985. These 43
patients include all patients in this period with an unequivocal
univentricular heart whose longitudinal data was available for follow-up.
We excluded patients who died within 1 week of surgery, patients lost to
follow-up, and patients with evidence of subaortic stenosis before banding.
Thirty-one of 43 patients (72.1%) developed subaortic stenosis subsequent
to banding of the main pulmonary artery. The mean age at banding of those
patients who developed subaortic stenosis was 0.21 years, and subaortic
stenosis was recognized at a mean age of 2.52 years. For the specific
cohort of patients whose ventricular morphology was a main chamber of left
ventricular type supporting the pulmonary artery and a rudimentary right
ventricle supporting the transposed aorta (32 patients), 27 developed
subaortic stenosis (84.4%). Subaortic stenosis in the classic form of
single ventricle usually results from progressive restriction of a wholly
muscular interventricular communication. Banding of the pulmonary artery by
producing myocardial hypertrophy undoubtedly accelerates the potential for
subaortic stenosis in these patients.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Subaortic stenosis, the univentricular heart, and banding of the pulmonary artery: an analysis of the courses of 43 patients with univentricular heart palliated by pulmonary artery banding
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