Surgical palliation of subaortic stenosis in the univentricular heart

Seventeen patients with a univentricular atrioventricular connection and subaortic stenosis at the outlet foramen level were seen from 1974 until 1983. The ventricular anatomy was of a single left ventricle with an outlet chamber, and the great arteries were transposed. This condition often followed pulmonary artery banding (15 cases) but also occurred with pulmonic stenosis (one) or pulmonary atresia (one). The median interval to the detection of subaortic stenosis after banding was 2.3 years (range 11 days to 15 years). Thirteen patients had a resting gradient to 118 mm Hg and three a gradient only with isoprenaline infusion. The following surgical procedures have been performed: (1) insertion of a conduit between the left ventricle and aorta (one patient); (2) creation of an aorticopulmonary window proximal to the band and tightening of the band (three patients); (3) enlargement of the ventricular septal defect (three patients); (4) Fontan procedure (five patients); and (5) Fontan procedure plus arterial switch (two patients). All of the procedures but the last one have met with significant mortality in this difficult group of patients.