Predictors of bulboventricular foramen restriction in patients with a dominant single left ventricle and ventriculoarterial discordance

OBJECTIVES: Early identification of patients at risk for bulboventricular foramen restriction is critical for selecting the most appropriate palliative strategy and preventing late reinterventions. The primary aim of our study was to identify parameters that predict bulboventricular foramen restriction in this patient population. METHODS: We retrospectively reviewed 17 patients with double-inlet left ventricle or tricuspid atresia associated with ventriculoarterial discordance who underwent staged palliation at our institution between August 2020 and December 2025. The bulboventricular foramen-to-aortic annulus ratio was measured by echocardiography, and receiver operating characteristic analysis was performed to identify a predictive cut-off. RESULTS: = 0.02). Receiver operating characteristic analysis showed that a pre-bidirectional cavopulmonary shunt bulboventricular foramen/aortic annulus ratio ≤ 0.65 predicted bulboventricular foramen restriction with an aortic annulus ratio of 0.87 (sensitivity 71%, specificity 83%). In multivariable. CONCLUSIONS: Pulmonary artery banding + arch reconstruction and a pre-bidirectional cavopulmonary shunt bulboventricular foramen/aortic annulus ratio ≤ 0.65 are associated with subsequent bulboventricular foramen restriction. In high-risk patients, performing a Damus-Kaye-Stansel anastomosis at the time of bidirectional cavopulmonary shunt may reduce the need for bulboventricular foramen enlargement and its related complications.