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A Large Animal Model for Pulmonary Hypertension and Right Ventricular Failure: Left Pulmonary Artery Ligation and Progressive Main Pulmonary Artery Banding in Sheep
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Pulmonary artery banding in dilative cardiomyopathy of young children: review and protocol based on the current

Dietmar Schranz1, Sabine Recla1, Ivan Malcic2

  • 1Pediatric Heart Center Justus-Liebig University Giessen, Giessen, Germany.

Translational Pediatrics
|June 5, 2019
PubMed

Insights

Pulmonary artery banding (PAB) can improve left ventricular (LV) function in infants with dilated cardiomyopathy (DCM) by altering ventricular-ventricular interactions (VVI). This approach offers a potential therapeutic alternative to heart transplantation (HTx) for pediatric heart failure.

Area of Science:

  • Pediatric Cardiology
  • Cardiac Surgery
  • Regenerative Medicine

Background:

  • Dilated cardiomyopathy (DCM) is a primary cause of pediatric cardiac death, with current treatments focusing on congestive heart failure (CHF) symptoms.
  • Cardiac regeneration potential in pediatric DCM, especially in infants, is often overlooked, leaving heart transplantation (HTx) as the sole life-saving but palliative option.
  • Existing therapeutic strategies for heart failure are limited, often neglecting the interplay between ventricular functions beyond basic hemodynamic parameters.

Purpose of the Study:

  • To propose a paradigm shift in pediatric heart failure treatment by modifying ventricular afterload through improved contra-lateral ventricular function.
  • To highlight the therapeutic potential of adverse ventricular-ventricular interactions (VVI) for functional recovery in pediatric DCM.
  • To review the perioperative management of reconstructive pulmonary artery banding (rPAB) as a strategy for functional recovery in pediatric DCM.

Main Methods:

  • Surgical placement of pulmonary artery banding (PAB) in infants and young children with left ventricular DCM and preserved right ventricular function.
  • Utilizing VVI to improve left ventricular (LV) function.
  • Review of current perioperative treatment protocols enabling the use of rPAB for functional recovery.

Main Results:

  • It is hypothesized that functional recovery can be achieved in nearly 80% of infants with LV-DCM, even those listed for orthotopic HTx.
  • rPAB can improve LV function via VVI in pediatric patients with LV-DCM.
  • This strategy can be implemented in centers without HTx capabilities.

Conclusions:

  • Pulmonary artery banding (PAB) offers a viable therapeutic alternative for pediatric DCM, potentially leading to functional recovery.
  • Harnessing ventricular-ventricular interactions (VVI) through rPAB represents a significant advancement in treating pediatric heart failure.
  • Further research is needed to elucidate the mechanisms of PAB-induced ventricular crosstalk and its modulation.

Keywords:
Dilative cardiomyopathychildrencongestive heart failure (CHF)pulmonary bandingrecovery

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