Extracardiac Conduit Fontan Operation and Right Ventricular Exclusion Procedure for Right Ventricle Failure after Repair of Partial Atrioventricular Septal Defect

A 13-year-old girl, who had undergone the total correction of partial atrioventricular septal defect at the age of 4 years, was admitted with severe tricuspid regurgitation in echocardiography. She had received one-and-a-half ventricle repair during follow-up. Her right ventricle showed global akinesia, and the ejection fraction of the left ventricle was 25% with paradoxical interventricular septal motion. We performed right ventricular exclusion adjunct to the Fontan procedure. She is doing well two years after the operation without complications.

The Clinical Outcomes of Damus-Kaye-Stansel Procedure According to Surgical Technique

BACKGROUND: The Damus-Kaye-Stansel (DKS) procedure is a method for mitigating the risk of systemic ventricular outflow tract obstruction (SVOTO). 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 2004 to April 2013. 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. There was no statistically significant difference in the median peak pressure gradient of preoperative subaortic stenosis in both groups: 14 mmHg (range, 4 to 53 mmHg) in group A and 15 mmHg (range, 0 to 30 mmHg) in group B (p=0.526). 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. No one had a recurrent SVOTO during follow-up. CONCLUSION: The DKS procedure is an effective way to minimize the risk of SVOTO, and there is little difference in the outcomes of the DKS procedure according to the surgical technique used.