Efficacy of Pulmonary Artery Banding in the Prevention of Pulmonary Vascular Obstructive Disease

Abstract

In 57 nonconsecutive pediatric patients (mean age: 2.6 months) with shunt-related pulmonary hypertension, the efficacy of pulmonary artery banding (PAB) was analysed retrospectively with special reference to the development of pulmonary vascular obstructive disease (PVOD). The patients were grouped in accordance to morphology, hemodynamics and incidence of PVOD. Efficacy of PAB was assessed by pulmonary to systemic pressure, flow and resistance ratios obtained by heart catheterization performed pre- and postoperatively. PAB was very effective in 49 out of 57 patients (= 85.9%), in 8 cases a progression or possible progression of PVOD must be suggested. Only Down syndrome can be considered as a predisposing factor for the development of PVOD. Based on our results we conclude that PAB is a high effective procedure in the prevention of PVOD; however, despite the surgical effectiveness of PAB, PVOD can occur. Strict post-PAB examination of pulmonary flow and resistance parameters is recommended and the definite surgical repair should be performed as early as possible.

Two-Stage Procedure for Pulmonary Vascular Obstructive Disease in Down Syndrome With Congenital Heart Disease

“…In this study, the efficacy of the 2-stage procedure of PAB and then ICR to prevent progression of pulmonary vascular disease [7][8][9] was proved by performing lung biopsies before each stage. When AVSD and VSD and/or PDA are complicated by early infantile PH, surgical intervention should be performed at an early stage.…”

“…4 It has been reported that a 3-month-old Down syndrome patient with absolute operative contraindication died shortly after ICR and another 2 patients who were aged 1 month and 4 months, respectively, and diagnosed as inoperable because of extremely thickened media of the small pulmonary arteries 3 died within 15 days after ICR. 5,6 For Down syndrome patients with CHD and associated PH, [7][8][9] it has been our policy since January 2000 to perform a 2-stage procedure, pulmonary artery banding (PAB) followed by ICR, in early infancy in early infancy to prevent such pulmonary vascular disease. Furthermore, Down syndrome patients often have complications of pulmonary diseases, such as interstitial emphysema or peripheral airway dilatation, during and after surgery, [10][11][12] which is attributable to congenital alveolar hypoplasia.…”

Chronic and adjustable pulmonary artery banding

“…ulmonary artery banding (PAB) is used in patients with a variety of cardiac malformations to reduce pulmonary blood flow 1,2 or to prepare the left ventricle for systemic afterload in cases of late referral for an arterial switch operation for transpostion of the great arteries. [3][4][5] Preparation of the left ventricle facing relatively low afterload for future systemic performance might also be required with the failing systemic right ventricle in atrial correction of transposition of the great arteries or in congenitally corrected transposition of the great arteries. 6 During a PAB operation, the optimum degree of constriction can not always be achieved at once.…”