Assessment of adequacy of pulmonary arterial banding by phonocardiogram.

Abstract

The phonocardiograms of 17 patients with ventricular septal defect and pulmonary arterial band were analysed in order to assess their use in evaluating the adequacy ofpulmonary arterial banding. In patients in whom the second heart sound was widely split (greater than 45 msec) the pulmonary arterial constriction was found to be adequate, with low pressure in the pulmonary artery distal to the band. The pulmonary component of the second sound was usually diminished.If, on the other hand, the second heart sound was narrowly split (less than 40 msec) with an increased pulmonary component, either the band was inadequate with persistent pulmonary arterial hypertension, or the band satisfactorily constricted the main pulmonary artery but was located at a distal position (greater than 2-I cm) from the pulmonary valve. In both of these situations, the pulmonary valve closing pressure was found to be increased giving rise to the narrowly split second sound.Pulmonary arterial banding is an effective palliative procedure in the treatment of children with ventricular septal defect, large leftto-right shunt, and pulmonary arterial hypertension. An appropriate constriction of the main pulmonary artery will result in reducing the pulmonary blood flow and pulmonary arterial pressure and probably will prevent progression of pulmonary vascular disease. The adequacy of the constriction may be assessed in terms of clinical improvement and by cardiac catheterization. The present study was undertaken to explore the usefulness of the phonocardiogram in evaluating the adequacy of the pulmonary artery banding.Material and methods Seventeen patients who had pulmonary arterial banding for ventricular septal defect were studied by cardiac catheterization I to IO years (mean 5-5 years) after pulmonary arterial constriction.In all but one patient, cardiac catheterization had also been performed before the pulmonary arterial banding. The age of the patients at the time of the postoperative catheterization varied between i-i and IO 9 years, with a mean of 5.9 years. The systolic pressure in the pulmonary arteries distal to the band was used to determine the adequacy of Received I2 January I972. 1 Supported in part by a grant of the National Heart and Lung Institute ofthe National Institutes of Health, Bethesda, Maryland, and a grant from the General Research Support, the Children's Hospital Medical Center, Boston, Massachusetts. the banding. If the systolic pressure in the pulmonary artery distal to the band exceeded 50 mmHg, the patients were classified as having inadequate bands; if the distal pressure was less than 50 mmHg, the patients were classified as having adequate bands.In addition to the pressure in the distal pulmonary artery, other measurements obtained at cardiac catheterization included the right ventricular pressure and the gradient across the band. Also, the pulmonary valve closing pressure (i.e. the diastolic pressure at the time of the dicrotic notch) and the mean diastolic gradient across the pulmonary valve were measured.T...

Second heart sound after pulmonary arterial banding operation.

“…Most of the patients studied by Aziz et al (1972) were over 4 years of age. other structures increase in size.…”

“…tenn Cclosure of the ventricular defect, and respiration. AGE 2~~~~~~~~~The same subject was not compared at different AGE 2!~A E heart rates, but no correlation was found between the A interval and heart rates of different subjects Aziz et al (1972). reported an inverse sound is delaye 33 to ms beyondthat t linear correlation between the distance the band ventricular pressure.…”

“…heart sound (Dammann et al, 1961;Stark et al, 1969), while others (Takahashi et al, 1968) have noted this splitting of the second sound as a Subjects and methods characteristic clinical finding after banding. Aziz, Mesko, and Ellison (1972) stressed the potential Only patients in severe distress had pulmonary value of the changes of the second heart sound after arterial banding. All had failed to respond to medical banding and presented data showing that with low treatment.…”