Management of Systemic Outlet Obstruction in Patients Undergoing Single Ventricle Palliation

Early or late systemic outlet obstruction in patients undergoing staged palliation for single ventricle variants may preclude a successful Fontan circulation. In assessing the patient presenting with real or impending obstruction, the surgeon is justified in pursuing an aggressive approach in protecting ventricular and semilunar valve function. Options include subaortic resection (transventricular, transatrial, or via a semilunar valve), modifications of the Damus-Kaye-Stansel connection, or a palliative arterial switch operation. In this review, the various options will be discussed and presented in the context of application to specific morphologic elements that make one more favorable than another in an individual patient.