Broekhuis E, Brizard C P, Mee R B, Cochrane A D, Karl T R
Cardiac Surgical Unit, Royal Children's Hospital, Melbourne, Australia.
Ann Thorac Surg. 1999 Feb;67(2):519-21. doi: 10.1016/s0003-4975(98)01140-0.
In patients with a univentricular arteriovenous connection, transection of the main pulmonary artery may be performed as part of a bidirectional cavopulmonary shunt or Fontan procedure. The proximal stump of the pulmonary artery may remain in the systemic circulation. In cases with a discordant ventriculoarterial connection, subsequent restriction of the bulboventricular foramen may lead to subaortic stenosis. The subaortic stenosis can be corrected in some patients by directing the systemic flow through a combined nonobstructed aortopulmonary outlet, as in the Damus-Kaye-Stansel connection. Previous closure of the pulmonary artery has been considered by some investigators to be a relative contraindication to the Damus-Kaye-Stansel procedure, unless an allograft root can be added to the circuit after excision of the closed pulmonary stump.
Three patients with previously transected pulmonary arteries underwent a modified Damus-Kaye-Stansel connection using the native pulmonary valve and the proximal pulmonary artery stump.
The native pulmonary valves have functioned well despite thrombus formation in the proximal stump in 2 patients before Damus conversion. All 3 patients are alive and well after 108, 19, and 3 months, with competent nonobstructed ventriculoarterial connections.
If transection and closure of the pulmonary artery as part of a previous palliation has spared the pulmonary valve, then the native pulmonary outlet might be used for a safe Damus-Kaye-Stansel connection.
在单心室动静脉连接的患者中，主肺动脉横断术可作为双向腔肺分流术或Fontan手术的一部分进行。肺动脉近端残端可能保留在体循环中。在心室动脉连接不一致的情况下，随后球室孔狭窄可能导致主动脉下狭窄。在一些患者中，可通过引导体循环血流经无梗阻的主动脉肺动脉联合出口（如Damus-Kaye-Stansel连接）来纠正主动脉下狭窄。一些研究者认为，既往肺动脉关闭是Damus-Kaye-Stansel手术的相对禁忌证，除非在切除关闭的肺动脉残端后能在循环中添加同种异体移植根部。
3例既往行肺动脉横断术的患者采用自体肺动脉瓣和肺动脉近端残端进行改良Damus-Kaye-Stansel连接。
尽管2例患者在Damus转换前近端残端形成血栓，但自体肺动脉瓣功能良好。3例患者分别在术后108个月、19个月和3个月时存活且情况良好，心室动脉连接无梗阻且功能正常。
如果作为既往姑息治疗一部分的肺动脉横断和关闭保留了肺动脉瓣，那么自体肺动脉出口可用于安全的Damus-Kaye-Stansel连接。
