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Updated: Mar 20, 2026
Author Spotlight: Investigating the Underlying Mechanisms of Right Ventricular Failure in Pulmonary Hypertension
Published on: June 14, 2024
[Serial Pathological Changes Between Pre- and Post-pulmonary Artery Banding in a 21-trisomy Patient with Ventricular
Ken Sato1, Yoshio Misawa, Masaaki Kawada
1Division of Cardiovascular Surgery, Jichi Medical University, Shimotsuke, Japan.
Insights
Pulmonary artery banding can prevent irreversible lung damage in 21-trisomy patients with ventricular septal defects and pulmonary hypertension. This two-stage repair approach shows reversible pathological changes in pulmonary vasculature and respiratory systems.
Area of Science:
- Cardiology
- Pediatric Surgery
- Genetics
Background:
- Ventricular septal defects (VSDs) often undergo primary intra-cardiac repair.
- Two-stage repair involving pulmonary artery banding is an alternative for specific cases.
- Patients with 21-trisomy (Down syndrome) present unique challenges due to pulmonary and respiratory fragility.
Observation:
- A case report details a 21-trisomy patient with VSD and pulmonary hypertension.
- The patient underwent pulmonary artery banding at 4 months, followed by radical repair at 27 months.
- Serial pathological assessments were conducted before and after pulmonary artery banding.
Findings:
- Pulmonary artery banding demonstrated reversibility of pathological changes in the pulmonary vasculature and respiratory systems.
- Heath-Edwards grade improved from II to 0.
- Index of pulmonary vasculature disease decreased from 1.1 to 1.0, indicating reduced disease severity.
Implications:
- Pulmonary artery banding is a viable strategy to prevent irreversible lung damage in VSD patients with pulmonary hypertension, particularly those with 21-trisomy.
- This approach may improve long-term outcomes by mitigating pulmonary vascular disease progression.
- The findings support a staged surgical approach for complex pediatric cardiac conditions with associated pulmonary issues.
Abstract:
Although many patients with a ventricular septa defect undergo primary intra-cardiac repair surgery, some patients require 2-stage repair with pulmonary artery banding. Patients with 21-trisomy, who exhibit fragility of the pulmonary vasculature and respiratory systems, may be candidates for this approach. Herein, we report the case of a 21-trisomy patient with ventricular septal defect associated with pulmonary hypertension. She underwent pulmonary artery banding at 4 months of age, and a subsequent radical operation at 27 months. Serial pathological findings between pre- and post-pulmonary artery banding revealed that changes of pulmonary vasculature and respiratory systems were reversible. Her Heath-Edwards grade changed from 0 from II and index of pulmonary vasculature disease changed from 1.1 to 1.0. In conclusion, pulmonary artery banding in a case with pulmonary hypertension prevented the lung from becoming irreversible pathological changes.
