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Pulmonary artery banding: analysis of a 25-year experience
M D Horowitz1, W S Culpepper, L C Williams
1Department of Surgery, Ochsner Clinic, New Orleans, Louisiana 70121.
Insights
Pulmonary artery banding is a useful palliative procedure for complex congenital heart defects. It is now reserved for severely ill infants with complex lesions not amenable to early correction, showing good outcomes when definitive repair is performed.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Pulmonary artery banding (PAB) has been utilized for decades as a palliative surgical approach.
- Its application has evolved with advancements in pediatric cardiac surgery and improved outcomes of primary repairs.
- This study reviews a 25-year experience with PAB in a diverse patient cohort.
Purpose of the Study:
- To analyze the long-term outcomes and evolving indications of pulmonary artery banding.
- To evaluate the efficacy of PAB as a palliative measure in complex congenital cardiac anomalies.
- To determine the current role of PAB in the management of infants and children with unrestricted pulmonary blood flow.
Main Methods:
- Retrospective review of 183 patients who underwent pulmonary artery banding between May 1962 and April 1987.
- Analysis of patient demographics, diagnoses, surgical outcomes, and subsequent definitive procedures.
- Categorization of diagnoses including ventricular septal defect, atrioventricular communis, and other complex anomalies.
Main Results:
- The cohort included infants and children aged two days to 60 months with various congenital cardiac anomalies.
- Early mortality was 22.3% (39 of 175 patients).
- Of 37 patients undergoing definitive operations after 1979, 86.5% (32) had excellent outcomes.
Conclusions:
- Pulmonary artery banding remains a valuable palliative procedure for specific complex congenital heart conditions.
- It is increasingly reserved for severely ill patients with complex lesions unsuitable for early definitive repair.
- Current indications include excessive pulmonary blood flow in single ventricle or tricuspid atresia, and certain cases of atrioventricular communis and ventricular septal defects.
Abstract:
A 25-year experience (May 1962 through April 1987) with pulmonary artery banding in 183 patients was reviewed and analyzed. Pulmonary artery banding was performed in a heterogeneous group of patients aged two days to 60 months (median, 10 weeks; mean, 21.8 weeks) and weighing 1.4 to 13.8 kg (mean, 4.2 kg). Diagnosis was ventricular septal defect in 76 (41.5%) and atrioventricular communis in 41 (22.4%). Pulmonary artery banding was also used in patients with d-transposition of the great vessels with ventricular septal defect, double-outlet right ventricle, univentricular heart, tricuspid atresia, and truncus arteriosus. Early death occurred in 39 of 175 patients who underwent pulmonary artery banding at Ochsner Foundation Hospital (22.3%). Definitive operation has been performed in 37 of the patients who underwent pulmonary artery banding since 1979 with excellent outcome in 32 (86.5%). Pulmonary artery banding is a useful palliative procedure for a diverse group of patients with congenital cardiac anomalies and unrestricted pulmonary blood flow. With improved results of primary repair of intracardiac anomalies in small infants, however, pulmonary artery banding should be reserved for severely ill patients with complex lesions not amenable to early definitive correction. Currently, pulmonary artery banding is indicated in patients with excessive pulmonary blood flow and single ventricle or tricuspid atresia. Pulmonary artery banding is also appropriate in certain patients with atrioventricular communis and in patients with muscular or multiple ventricular septal defects. Pulmonary artery banding is an option in patients with ventricular septal defect and coarctation of the aorta.