Abstract
We report the case of a young child with tricuspid atresia, discordant ventriculoarterial connection, rudimentary right ventricle, and mildly restrictive bulboventricular foramen. Intraoperative temporary snaring of the modified Blalock-Taussig shunt resulted in a dramatic volume reduction of the left ventricle, a decrease in bulboventricular foramen size, and an instantaneous increase in the gradient across the latter from 15 mm Hg before occlusion of the shunt to 44 mm Hg. A modified Damus-Stancel-Kaye procedure resulted in early relief of the aortic outflow obstruction; in addition, a bidirectional cavopulmonary anastomosis was constructed. The use of intraoperative echocardiography is recommended to monitor subaortic obstruction in procedures that unload volume in univentricular hearts with discordant ventriculoarterial connection.
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