Modification of Trusler's Formula for the Pulmonary Artery Banding

Baslaim, Ghassan

doi:10.1016/j.hlc.2009.02.003

Cited by 15 publications

(11 citation statements)

References 7 publications

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“…According to several studies (LeBlanc et al 1987;Van Nooten et al 1989;Yoshimura et al 2005;Ohashi et al 2006;Baslaim et al 2009), the average interval between PAB and ICR varied from 12.4 to 34.8 months. However, no report has elucidated the optimal timing for ICR after PAB.…”

Section: Discussionmentioning

confidence: 99%

“…Trusler and Mustard (1972) advocated that an adequate circumference for PAB in infants with VSDs without mixed disorders was 20 mm + 1 mm for each kilogram of BW. This formula has been widely accepted by many institutions (Takayama et al 2002;Baslaim 2009). On the basis of their clinical findings, their group later stated that the band should be approximately 1 mm tighter in infants weighing 2 kg or less (Albus et al 1984).…”

Section: Discussionmentioning

confidence: 99%

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Pulmonary Artery Banding for Neonates and Early Infants with Low Body Weight

Nagashima

Okamura

Shikata

et al. 2011

Tohoku J. Exp. Med.

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Open heart surgery for infants with low body weight (BW) remains still a challenge. Pulmonary artery banding (PAB) is a useful surgical palliation for small neonates and early infants with excessive pulmonary blood flow who are unable to withstand a heart surgery. This study retrospectively reviewed neonates and infants who underwent PAB to assess the surgical results and the validity of our PAB. We selected 38 acyanotic infants and neonates and divided them into 2 groups: low BW (< 2.5 kg, n = 15, group L) and normal or high BW (≥ 2.5 kg, n = 23, group NH). The average BW at the time of PAB was 2.8 ± 1.1 kg (range, 1.2-5.8 kg), and the average age at the time of PAB was 41.8 ± 44.8 days (range, 2-151 days). Using a 3-mm-wide polyester tape, we tightened the main pulmonary artery to obtain the circumference of (19 mm + 1 mm for each kg of BW). There was no early death but one late death in each group. Postoperative BW continuously increased 1 month after PAB in both groups, although BW was significantly lower in group L than in group NH. Intracardiac repair (ICR) was accomplished in 31 patients (13 in group L and 18 in group NH) at average ages of 1.5 years, while the remaining 5 patients are awaiting ICR. In conclusion, PAB using our formula for the infants even weighing < 2.5 kg has low mortality and is effective as a bridge to ICR.Keywords: infant; low birth weight; neonate; palliative surgery; pulmonary artery banding Tohoku J. Exp. Med., 2011, 225 (4), 255-262. © 2011 Tohoku University Medical PressIn neonates and early infants with low body weight (BW), cardiopulmonary bypass surgery increases organ edema and dysfunction, leading to high mortality and morbidity (Oppido et al. 2004). Pulmonary artery banding (PAB) remains a useful surgical palliation for small neonates and early infants with excessive pulmonary blood flow who are unable or difficult to withstand an open heart surgery using cardiopulmonary bypass. PAB can relieve the symptoms of heart failure and respiratory distress and prevent future pulmonary vascular obstructive disease in these infants and intracardiac repair (ICR) can be delayed until they grow. Trusler and Mustard (1972) advocated that the adequate circumference of the PAB using a 4-mm-wide tape in infants without cyanosis was (20 mm + 1 mm for each kg of the infant BW). The Trusler's formula has been used as a standard for PAB in pediatric cardiac surgery field for a long period. However, the average birth BW in the Japan is lower than in the United States and European countries and per se decreased in the recent years. A wider tape for PAB may cause the distal PA stenosis in small neonates and infants. In addition, the average BW in our PAB series was much lower than that reported previously. Therefore, in our institution, we have routinely used a 3-mm-wide tape (1 mm narrower than Trusler's group) and our modified formula (19 mm + 1 mm for each kg of BW), 1 mm shorter circumference than Trusler's formula] had been applied to obtain the appropriate PAB circumference (Fig. 1). Accord...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pulmonary Artery Banding for Neonates and Early Infants with Low Body Weight

Nagashima

Okamura

Shikata

et al. 2011

Tohoku J. Exp. Med.

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“…Techniques of PAB have been described [ 19 ]. The Trusler Formula [ 20 ] involves sizing the band according to the specifi c cardiac anatomy and setting the initial length of the band based on the patient's weight.…”

Section: Pulmonary Artery Banding (Pab)mentioning

confidence: 99%

Physiologic Repair of Congenitally Corrected Transposition of the Great Arteries

Said

Dearani

2016

Surgery of Conotruncal Anomalies

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Surgery for congenitally corrected transposition of the great arteries (ccTGA) has evolved overtime. Anatomical repair of ccTGA is now performed with quite satisfactory outcomes in children. The double switch operation has become the preferred surgical procedure in selected cases. Nevertheless, a number of patients with ccTGA still require physiological repair due to complex cardiac associations or impaired systemic ventricular function. This chapter outlines the mechanisms of right ventricular failure in ccTGA. Several "old techniques of repair" were abandoned. The introduction of PA banding has reduced the occurrence of tricuspid regurgitation and has allowed, in some cases, anatomical repair after proper LV retraining. The indications for TV repair and replacement, the place of the Fontan operation or heart transplantation are discussed. The decision to proceed with physiologic versus anatomic repair and the timing of operation is individualized.

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“…Currently, there is no firm consensus among surgeons regarding optimal band tightness based on morphology and body weight [4][5][6]. Some surgeons adjust the tightness based on the intraoperative pulmonary blood flow ratio to the systemic blood flow (Qp/Qs) [4] and others use the arterial oxygen saturation (SaO 2 ) as a target [6].…”

mentioning

confidence: 99%

“…Some surgeons adjust the tightness based on the intraoperative pulmonary blood flow ratio to the systemic blood flow (Qp/Qs) [4] and others use the arterial oxygen saturation (SaO 2 ) as a target [6]. Other indicators include increase in systemic blood pressure, the pressure gradient across the band, and diagnosis-based decision (ie, single-ventricle vs biventricular physiology) [3,5,6].…”

mentioning

confidence: 99%