Related Experiment Videos
Late banding operation in children with ventricular septal defect and pulmonary arterial hypertension
Insights
Pulmonary artery banding for large ventricular septal defects with pulmonary hypertension showed limited success in reducing pulmonary vascular resistance in children. Long-term follow-up revealed minimal improvement in most patients, questioning the procedure's efficacy.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
Background:
- Large ventricular septal defects (VSD) can lead to pulmonary arterial hypertension (PAH).
- Pulmonary artery banding (PAB) is a palliative surgical approach for complex congenital heart disease with PAH.
Purpose of the Study:
- To evaluate the long-term effectiveness of pulmonary artery banding in reducing pulmonary vascular resistance (PVR) in children with large VSD and PAH.
Main Methods:
- Retrospective analysis of 31 children (2-10 years) who underwent PAB for large VSD and PAH.
- Recatheterization of 22 children 3-5 years post-PAB to assess pressure and resistance.
- Analysis of oxygen breathing test results pre-PAB.
Main Results:
- Only 8 of 22 recatheterized children showed a significant pressure decrease distal to the band.
- Pulmonary vascular resistance decreased to near-normal levels in only 2 children.
- No significant improvement or even an increase in PVR was observed in the majority of patients.
- Poor correlation between pressure reduction and PVR changes was noted.
- Preoperative oxygen breathing test predicted limited PVR reduction post-PAB in some cases.
Conclusions:
- Pulmonary artery banding offers limited long-term benefit in reducing pulmonary vascular resistance in children with large VSD and PAH.
- The procedure's efficacy in normalizing pulmonary hemodynamics is questionable.
- Further investigation into alternative or adjunctive treatments is warranted.
Abstract:
Since 1960 31 children, 2-10 years old, with large ventricular septal defects and pulmonary arterial hypertension, underwent pulmonary artery banding in Munich. 22 of these children were recatheterized 3-5 years after the operation. Only 8 of these children were shown to have a definite decrease in pressure distal to the band, and in only 2 of these children a reduction of pulmonary vascular resistance to values at the upper limit of normal could be shown. In the remaining children either little or no alteration and rarely even a definite increase of pulmonary vascular resistance was found. There was only a poor correlation between pressure changes and resistance changes. During preoperative catheterization oxygen breathing was shown to produce a more than 50% reduction in the pulmonary arterial pressure in 8 cases. Of these, only 5 showed a decrease of pulmonary vascular resistance after pulmonary artery banding. This decrease, however, was relatively small.