Pulmonary artery banding in infants and young children with left ventricular dilated cardiomyopathy: A novel therapeutic strategy before heart transplantation

Schranz, Dietmar; Rupp, Stefan; Müller, Matthias J.; Schmidt, Dorle; Bauer, Anna; Valeske, K.; Michel‐Behnke, Ina; Jux, Christian; Apitz, Christian; Thul, Josef; Hsu, Daphne T.; Akintürk, Hakan

doi:10.1016/j.healun.2013.01.988

Cited by 79 publications

(84 citation statements)

References 16 publications

(16 reference statements)

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“…Recently, this mechanism has been harnessed in the setting of dilated LV cardiomyopathy. Schranz and colleagues 103 have performed pulmonary artery banding in 12 infants and toddlers with left heart failure, showing remarkable improvements in LV ejection fraction, reduction in LV size, and improved mitral regurgitation. Although clearly preliminary, this may be another method of harnessing potential beneficial ventricular-ventricular interactions that deserves further investigation.…”

Section: March 4 2014mentioning

confidence: 99%

Right Versus Left Ventricular Failure

2014

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1033V entricular failure manifests in many forms, its underlying physiology ranging from overt left ventricular (LV) systolic dysfunction to isolated right ventricular (RV) diastolic dysfunction, and the wide portfolio of resulting symptoms vary from chronic fluid retention to acute multiorgan dysfunction and death. In this review, we discuss the morphological, functional, and molecular similarities and differences in RV and LV responses to adverse loading and failure. We further discuss whether LV and RV function and failure can truly be discussed as separate entities and thereby examine interactions between the ventricles that on one hand contribute to ventricular dysfunction but on the other may be harnessed for therapeutic benefit. Embryological and Physiological Differences Between the RV and LVThe RV and LV have different embryological origins.1 The LV originates from the primary heart field; the RV, from the secondary heart field. Consequently, several genes specifically control RV formation, including, among others, Hand2 and Tbx20.2 During gestation, the RV functions as the systemic ventricle ( Figure 1A). During fetal life, in addition to supplying the modest amount of pulmonary blood flow, the RV pumps blood to the lower body and placenta and contributes more than half of the combined cardiac output.3 With the transition from fetal to postnatal physiology and with the reduction in pulmonary vascular resistance, the subpulmonary RV transforms its morphology and geometry, becoming a thin-walled chamber to adopt its postnatal physiological characteristics. 4 Because it faces a low impedance pulmonary circulation, the normal postnatal RV maintains a cardiac output equal to that of the LV at approximately a fifth of the energy cost. The trapezoidal RV pressure-volume loop reflects this difference, with few if any isovolumic periods. Consequently, RV output starts early during pressure generation and is later maintained by a "hangout period" when antegrade flow continues into the pulmonary artery despite the onset of RV relaxation.5 In contrast, the rectangular LV pressure-volume loops reflect the LV square-wave pump function with distinct and well-developed isovolumic contraction and relaxation periods.6 Likewise, RV myocytes display faster twitch velocities than LV myocytes. 7The physiological differences are reflected in morphological differences between the ventricles (Table 1). The low-pressure RV is triangular in the sagittal plane and crescent-shaped in cross section as a result of the concave RV free wall and convex interventricular septum wrapping around the high-pressured, thick-walled, bullet-shaped LV. Consequently, although the normal RV has a lower ratio of volume to surface area and a thinner wall than the LV, 8 the low cavity pressure determines a lower wall stress and lower oxygen demands.Anatomic differences are also apparent in myocardial architecture. LV subepicardial and subendocardial fibers are oblique and helical with fiber angles ranging from 30° to 80° with a mean of ≈60°, whereas ...

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Section: March 4 2014mentioning

confidence: 99%

Right Versus Left Ventricular Failure

2014

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“…Surgical pulmonary artery banding (PAB) has recently been proposed as a novel therapy in infants with severe left sided dilated cardiomyopathy (DCM) (1). Initial outcome data in a small cohort of patients undergoing PAB revealed a decrease in left ventricular (LV) dimensions and an improvement in LV function (1).…”

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confidence: 99%

“…Initial outcome data in a small cohort of patients undergoing PAB revealed a decrease in left ventricular (LV) dimensions and an improvement in LV function (1). Although potential mechanisms that may recover LV function have been suggested, a comprehensive analysis of RV response to PAB and its subsequent impact on LV remodelling is mandatory to delineate the effects of this procedure.…”

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confidence: 99%

Biventricular response to pulmonary artery banding in children with dilated cardiomyopathy

Latus

Hachmann

Gummel

et al. 2016

The Journal of Heart and Lung Transplantation

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“…Clinical studies are so far lacking, but the first experience of a similar approach using banding of the pulmonary trunk in children with left ventricular failure owing to dilated cardiomyopathy has shown promising results. 152 Improved understanding of ventricular-ventricular interactions can rapidly translate to clinical benefit, and enhance the management of these patients. Furthermore, the sometimes counterintuitive effects of therapeutic modification of ventricular afterload to improve contralateral ventricular function via Anrep effects-that is, increased contractility induced by increased afterload-are an exciting new area of investigation.…”

Section: Aortic Bandingmentioning

confidence: 99%

Treatment of pulmonary arterial hypertension in children

Latus,

Delhaas,

Schranz

et al. 2015

Nat Rev Cardiol

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Pulmonary arterial hypertension (PAH) is an important cause of morbidity and mortality in children. Improved understanding of the pathophysiological mechanisms of the underlying diseases has resulted in the development of effective, but not yet curative, therapies. Currently, drugs from three main pharmacological groups targeting specific aberrant pathways (endothelin, nitric oxide, and prostacyclin) and four routes of administration (inhaled, intravenous, oral, and subcutaneous) have been approved for adult patients with PAH. However, only a minority of these drugs has been officially approved for children, mainly because randomized controlled studies are limited by the small number of paediatric patients with PAH worldwide. In children with progressive, severe PAH and an inadequate response to drug therapy, advances in interventional and surgical approaches have provided promising new strategies to avoid right ventricular deterioration. These techniques can delay or even avoid the need for lung transplantation. In this Review, we present an update on developments in drug therapy for patients with PAH and highlight the current status of these treatments in children. We also describe the new surgical, interventional, and hybrid procedures, as well as their practical application in children with severe PAH.

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Pulmonary artery banding in infants and young children with left ventricular dilated cardiomyopathy: A novel therapeutic strategy before heart transplantation

Cited by 79 publications

References 16 publications

Right Versus Left Ventricular Failure

Right Versus Left Ventricular Failure

Biventricular response to pulmonary artery banding in children with dilated cardiomyopathy

Treatment of pulmonary arterial hypertension in children

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