Tailored therapy for aggressive dilatation of systemic veins and arteries may result in improved long-term Fontan circulation

Abstract

switch procedure. Pulmonary artery banding is not a benign procedure, and mechanical support after surgery can be unpredictable, with the potential for significant bleeding issues as a result of anticoagulation. In this particular case, the presence of a restrictive muscular VSD provided the opportunity to stent the VSD open to allow preparation of the left ventricle. Stenting the VSD obviated the need for initial palliative surgery and allowed easy monitoring of the progress of the left ventricle. One caveat with this technique is that not all VSDs are amenable to stenting, because the risk of inducing heart block is high in the more commonly seen perimembranous type of VSD. In this reported case, the VSD was muscular, however, which made the risk of heart block low. The use of interventional cardiology procedures for initial palliation is a relatively new and promising alternative. Some groups have explored stenting of the right