Surgical management of XXXX in single left ventricle and @entity1145 .

@entity1 @entity1145 @entity1184 @entity254 @entity1757 @entity3888 @entity616
@entity3888 caused by either a restrictive bulboventricular foramen in single left ventricle with an outflow chamber or by a restrictive @entity1757 in @entity1145 with transposition of the great arteries can lead to a @entity1184 , noncompliant ventricle and excessive pulmonary blood flow. This combination is disadvantageous to potential Fontan procedure candidates because they are dependent on good ventricular function and low pulmonary vascular resistance for survival. The results of surgical procedures to directly or indirectly relieve significant @entity3888 (gradient greater than 30 mm Hg) in 24 @entity1 , 16 with single left ventricle and 8 with @entity1145 , were reviewed. Four @entity1 had a left ventricular apex to descending aorta valved conduit; none survived. Seven @entity1 had resection of subaortic tissue; four survived and four developed @entity616 at surgery. Adequate gradient relief was evident in only one of the four survivors. Thirteen @entity1 had a main pulmonary artery to ascending aorta @entity254 or conduit; six survived. All survivors had adequate gradient relief. The overall survival was 42% (10 of 24). None of seven @entity1 with a subaortic gradient greater than 75 mm Hg survived. These data show that: Surgical relief of established @entity3888 in @entity1 with single left ventricle and @entity1145 carries a high mortality rate, especially if the subaortic gradient is greater than 75 mm Hg. The best procedure appears to be the pulmonary artery to ascending aorta @entity254 . A clearer understanding of the factors leading to the development of significant @entity3888 is necessary to prevent it or to devise improved therapeutic strategies.
