Surgical aortico-pulmonary anastomosis for a complex aortic obstruction with single ventricle

Abstract

Management of the neonate and infant with single ventricle and obstruction to systemic blood flow remains controversial and carries significant risk. Options include a neonatal pulmonary artery banding procedure or a pulmonary artery (PA)-to-aortic anastomosis and systemic-to-pulmonary artery shunt. A series of 162 patients with tricuspid atresia or other forms of single ventricle presented between 1985 and 1991, and in 71, there was unrestricted pulmonary blood flow. Of these, 41 had initial pulmonary artery banding with 3 deaths, whereas 5 of 29 patients undergoing PA-to-aortic anastomosis died early. However, when the patients were analyzed by whether aortic arch obstruction was also present, 66.7% ( 4 6 ) of patients managed with PA banding plus arch repair eventually died, whereas only 40% ( 10 25 ) died at some point after PA-aortic anastomosis plus arch repair. Continued experience and follow-up are necessary to improve the outcome of patients with single ventricle and systemic blood flow obstruction.