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Percutaneous pulmonary artery debanding
Hideshi Tomita1, Takanari Fujii1, Hiroaki Kise1
1Pediatric Heart Disease & Adult Congenital Heart Disease Center, Showa University, Tokyo, Japan.
Insights
Percutaneous pulmonary artery debanding (p-debanding) using balloons and stents is feasible and effective for palliative or total procedures. This technique safely improves pulmonary artery diameter and oxygen saturation in patients with pulmonary artery banding.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Pediatric Cardiology
Background:
- Limited data exists on percutaneous pulmonary artery debanding (p-debanding), especially with stenting.
- Pulmonary artery banding (PAB) is a palliative procedure for congenital heart defects.
Purpose of the Study:
- To evaluate the feasibility and effectiveness of palliative or total percutaneous pulmonary artery debanding (p-debanding).
- To determine safe balloon sizing parameters for p-debanding procedures.
Main Methods:
- Retrospective review of 12 p-debanding procedures in 8 patients.
- Balloon diameters were chosen based on the circumference of the pulmonary artery band (30-50% for palliative, >50% for total).
- Stents were used in 2 palliative cases; balloon diameter did not exceed 1.5 times the reference vessel diameter.
Main Results:
- Pulmonary artery banding diameter increased significantly (p<0.01) post-p-debanding.
- Arterial oxygen saturation (SaO2) improved significantly (p<0.01) in patients with hypoxia.
- No significant pulmonary hypertension was observed post-procedure.
Conclusions:
- Palliative or total p-debanding using balloons and/or stents is generally feasible and effective.
- Specific balloon sizing (35-50% of band circumference for palliative, >50% for total, <1.5x reference vessel diameter) is safe and effective.
Background:
There is a paucity of data on palliative or total percutaneous pulmonary artery debanding (p-debanding), particularly with use of a stent.
Methods:
Twelve p-debandings in eight patients were included in this study. Age at pulmonary artery banding (PAB) ranged from 3 days to 1 year (median, 13 days), while p-debanding was performed at 2-157 (7) months. The body weight at the p-debanding ranged from 3.2 to 22.2 (7.3) kg. We chose the balloon diameter of 30-50% to the circumference of the band for palliative, and larger than 50% for total p-debanding, respectively. In either way, the balloon diameter did not exceed 1.5 times the reference vessel diameter. Stent was implanted for palliative p-debanding in 2 patients.
Results:
1. The circumference of the band ranged from 16 to 23 (20) mm, while the balloon diameter ranged from 20-60 (40)% to that, where larger than 50% was used for 2 procedures intended total p-debanding. 2. PAB diameter increased from 2.5-4.7 (3.0) mm to 2.8-9.5 (4.5) mm (p<0.01), however, there was no significant change in the diameter in 2 procedures. In one patient, p-debanding was the definitive treatment associated with spontaneous near closure of muscular ventricular septal defect, in another patient of congenitally corrected transposition of the great arteries, severely depressed left ventricular ejection fraction was recovered following p-debanding. 3. Arterial oxygen saturation (SaO2) increased from 64-97 (80)% to 66-95 (90)% (p<0.01), while in 10 procedures of 6 patients where the indication of p-debanding was hypoxia, SaO2 increased in 8 procedures. There was no significant pulmonary hypertension following p-debanding.
Conclusion:
Palliative or total p-debanding using balloon and/or stenting is generally feasible and effective. A balloon diameter 35-50% to the band circumference in palliative, and more than 50% in total p-debanding, while in either way less than 1.5 times the reference vessel diameter, is safe.
