IntroductionThere are several types of congenital heart disease which may be complicated by pulmonary hypertension (PH) following excessive pulmonary blood flow, such as large ventricular septal defect (VSD), double outlet right ventricle, and single ventricle.Primary repair is generally accepted as the best option for such diseases, although pulmonary artery banding (PAB) is occasionally indicated as a palliative procedure for situations in which primary repair has a considerable risk. We report on the case of a patient with coarctation of the aorta (CoA) complicated by multiple muscular VSDs (Swiss cheese type) for whom we performed arch repair and PAB as the first-stage surgery. His VSDs spontaneously became smaller following PAB, consequently, we chose to perform percutaneous pulmonary debanding rather than surgical debanding. We also created a model of the PAB and studied the anatomic development.
A B S T R A C TPulmonary artery banding (PAB) is a standard operation for various congenital heart defects complicated by pulmonary hypertension (PH) and judged unsuitable for primary intracardiac repair. We report successful percutaneous pulmonary artery debanding in a baby complicated by muscular ventricular septal defect (VSD), that was initially large and multiple, but closed spontaneously later. The 5-monthold boy was referred to our hospital on day 3, diagnosed as having aortic coarctation (CoA), with multiple muscular VSDs and severe PH. On day 6, he underwent CoA repair and PAB using expanded polytetrafluoroethylene (ePTFE), while the muscular VSDs were left open. We planned percutaneous pulmonary debanding at the age of 5 months, as the muscular VSDs had become small. After dilation with a Mustang 1 (Boston Scientific, Marlborough, Massachusetts, United State) balloon (12 mm diameter) there was a persistent waist indicating a residual narrowing. Use of an extra-high pressure balloon, Conquest 1 (Medicon, Osaka, Japan) balloon of the same size, completely eliminated the waist. In in vitro experiments, the Mustang 1 partially tore the ePTFE, while a Conquest 1 of the same diameter completely opened the band. The mechanism of debanding was tearing of the ePTFE by the knot of the suture thread. Percutaneous pulmonary debanding to avoid unnecessary surgery is feasible in such a patient if the VSD becomes small.