A flow restrictor implanted percutaneously across a loose pulmonary artery band

Pulmonary artery banding usually is performed as a palliative procedure. In patients with elevated pulmonary vascular resistance and complex congenital heart disease, it may not be possible at the time of surgery to obtain sufficient restriction to optimize the patient for further treatment; additional restriction may be needed in time. We present a technique where we used a combination of two devices (a 10-mm Amplatzer ASD occluder fenestrated with a Palmaz Genesis 9/19 mm stent) to percutaneously further reduce the flow to the lungs 1 month after surgical placement of a pulmonary artery band in a 16-year-old girl with complex univentricular heart. Eight months after the banding the patient successfully underwent completion of the Fontan circulation by total cavopulmonary connection. This technique allows to reduce flow without redo surgery. In well-selected patients, this new percutaneous technique allows to better prepare such complex patients for future surgery.