Does banding the pulmonary artery affect pulmonary valve function after the Damus-Kaye-Stansel operation?

Abstract

The Damus-Kaye-Stansel (DKS) operation can be an effective palliation in patients who have single-ventricle physiology and systemic outflow obstruction. Pulmonary artery banding (PAB) may be used as a preliminary procedure in these patients to limit overperfusion of the pulmonary circulation. In some series, the DKS operation has been associated with pulmonary insufficiency (PI). We retrospectively analyzed medical records of our patients who had PAB and later DKS to determine the incidence of PI in these patients. Between 1982 and 1996, 15 patients underwent PAB before DKS. Median age at PAB placement was 7 days and median duration of PAB was 7 months. Echocardiograms obtained before PAB, before DKS, and at the most recent post-DKS follow-up were reviewed. Follow-up ranged from 1 to 15 years (mean follow-up, 7.5 years). One patient had trivial PI before PAB, which progressed to moderate PI at the last follow-up. Only 1 other patient had mild PI, but only at the last follow-up after DKS. These findings suggest that prior PAB does not appear to cause significant PI in patients slated for DKS, and the incidence of significant PI after the DKS operation is relatively low.