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Pulmonary artery banding in infants with complete atrioventricular canal
Insights
Pulmonary artery banding can effectively manage symptomatic complete atrioventricular canal (AVC) in infants with congestive heart failure (CHF). This palliative procedure offers a survival benefit for infants with large ventricular shunts and minimal mitral insufficiency.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Surgical Management
Background:
- Symptomatic complete atrioventricular canal (AVC) in infants presents management challenges.
- Congestive heart failure (CHF) is a common complication in infants with complete AVC.
Purpose of the Study:
- To evaluate the effectiveness of pulmonary artery banding as a palliative treatment for infants with complete AVC and CHF.
- To identify patient subgroups who may benefit most from this surgical intervention.
Main Methods:
- Retrospective review of 31 infants with complete AVC and CHF treated between 1969 and 1977.
- Comparison of outcomes between medical management and pulmonary artery banding.
Main Results:
- Fifteen infants responded to medical management.
- Ten infants underwent pulmonary artery banding; seven survived the operation.
- Six long-term survivors had minimal mitral insufficiency and large ventricular shunts.
- Three patients who died after banding had significant mitral insufficiency.
Conclusions:
- Pulmonary artery banding is an effective palliative procedure for select infants with complete AVC and CHF.
- Optimal candidates for banding have large ventricular shunts and minimal mitral insufficiency.
Abstract:
Management of symptomatic atrioventricular canal (AVC) in infancy may be difficult. Between July, 1969, and September, 1977, 31 infants with complete AVC presented in congestive heart failure (CHF) to the University of Minnesota Hospitals. Fifteen of these patients have responded to medical management and have been followed as outpatients. The other 16 patients remained in CHF. Six of them died of persistent heart failure within 4 months. The other 10 infants, aged 3 weeks to 1 year (mean 4 months), underwent pulmonary artery banding and seven survived operation. One of the survivors died with apparent pneumonia 1 month postoperatively. Each of the remaining six patients, who have been followed for 9 months to 9 years, had minimal mitral insufficiency and a large ventricular shunt. The three patients dying after banding had significant mitral insufficiency. We believe that pulmonary artery banding is an effective palliative procedure for infants with complete AVC and CHF who have large ventricular shunts and minimal mitral insufficiency.