Pulmonary artery banding with a novel percutaneously, bidirectionally adjustable device

Abstract

Pulmonary artery banding is commonly performed as a palliative procedure in complex congenital heart disease, when pulmonary blood flow is increased. However, the hemodynamics may change postoperatively requiring readjustment of the band, which may necessitate a second operation. We report a new system for pulmonary artery banding which allows precise placement of the band intraoperatively, as well as bidirectional percutaneous adjustment of the band postoperatively. Via left lateral thoracothomy the new device was implanted without complications into a neonate with congestive heart failure due to tricuspid atresia (IIc) and coarctation of the aorta. Although optimal placement of the band had been achieved intraoperatively the band had to be tightened 25 h after the operation and released 85 h after the operation in order to optimize hemodynamics. The bidirectionally adjustable device for banding of the pulmonary artery is superior to previously used devices with either no or unidirectional adjustability of the band because it is safe and easy to implant and has the potential to reduce the number of reoperations associated with this type of procedure.

Modification of Trusler's Formula for the Pulmonary Artery Banding

“…This has led to the development of several adjustable PAB devices [6][7][8]. However, none of these devices have gained widespread clinical use since they are expensive special equipment, unreliable and lacking reproducibility of adjustments.…”

A method of transcutaneously adjustable pulmonary artery banding for staged left ventricular retraining

“…The most notable current examples include the clinical experience with the FloWatch device, [6][7][8] the use of an adjustable gastric band device, 9 and several thorascopic and openly applied adjustable homemade devices. [10][11][12][13] The FloWatch device is conceptually sound but is not available in the United States and is not applicable to all size patients and all anatomic subtypes.…”

Remote Control of Pulmonary Blood Flow

“…Several experimental and clinical studies have been performed and reported trying to address the above concerns, due to the evidence that a fixed band doesn't fulfil the continuously variable clinical requirements; the aim of the studies was to design an adjustable pulmonary artery banding allowing for external regulation during the hours or days following the surgical procedure [17,[47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64].…”