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Updated: Aug 19, 2026
A Pulmonary Trunk Banding Model of Pressure Overload Induced Right Ventricular Hypertrophy and Failure
Published on: November 29, 2018
[Pulmonary artery banding for double inlet left ventricle]
1Department of Pediatric Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical College.
Insights
Pulmonary artery banding (PAB) in double-inlet left ventricle patients effectively reduced pulmonary pressures, maintaining adequate ventricular function for subsequent septation procedures. This indicates PAB is a viable strategy for managing these complex congenital heart conditions.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Cardiac Surgery
Context:
- Double-inlet left ventricle (DILV) is a complex congenital heart defect requiring staged surgical palliation.
- Pulmonary artery banding (PAB) is often used to control pulmonary blood flow in DILV patients.
- Assessing the impact of PAB on ventricular function and suitability for later septation is crucial.
Purpose:
- To evaluate the hemodynamic and functional changes following pulmonary artery banding in DILV patients.
- To determine if PAB preserves adequate ventricular volume and cardiac function for successful septation.
- To analyze the incidence of subaortic stenosis post-PAB.
Summary:
- Thirteen DILV patients undergoing PAB showed significant reductions in pulmonary-systemic arterial pressure ratio and mean pulmonary arterial pressure.
- Ventricular end-diastolic volume decreased post-PAB, but remained sufficient for septation in most cases.
- Ejection fraction significantly decreased, while pulmonary resistance and ventricular end-diastolic pressure showed no significant changes. Three cases developed subaortic stenosis.
Impact:
- Pulmonary artery banding effectively manages pulmonary hypertension in DILV patients.
- Patients undergoing PAB maintain adequate ventricular reserve for subsequent septation.
- PAB is a safe and effective palliative strategy in the management of DILV, though subaortic stenosis requires monitoring.
Abstract:
Thirteen patients with double-inlet left ventricle who had undergone pulmonary artery banding (PAB) were reviewed. At the time of PAB, the age ranged from 2 months to 3 years. Pulmonary-systemic arterial pressure ratio and pulmonary arterial mean pressure were reduced from 0.95 +/- 0.12 to 0.4 +/- 0.18, and from 57.3 +/- 11.6 mmHg to 29.9 +/- 12.7 mmHg after PAB. Pulmonary resistance showed no statistically significant change after PAB. (from 7.6 +/- 5.2 unit to 4.8 +/- 3.9 unit) Ventricular end-diastolic volume decreased from 379.9% +/- 140.0% to 275.7% +/- 118.0% after PAB. The smallest one was 170% who successfully underwent septation procedure. Ejection fraction significantly decreased from 64.5 +/- 6.1% to 56.3 +/- 7.9%. (p less than 0.005) Ventricular end-diastolic pressure showed no significant change after PAB. (from 9.2 +/- 2.8 mmHg to 9.9 +/- 2.0 mmHg) After PAB subaortic stenosis occurred in three cases and pressure gradient were 10, 20, and 85 mmHg, respectively. Seven cases, including three cases with subaortic stenosis, underwent septation procedure and all survived. Before septation, ventricular end-diastolic volume calculated as % of normal left ventricular volume ranged from 173% to 570% and pulmonary resistance ranged from 1.6 unit to 11 unit. These data suggested that the patients with double-inlet left ventricle had efficient ventricular volume and cardiac function for septation even after PAB.
