Reevaluating echocardiographic indicators in bilateral pulmonary artery banding

This letter critically examines the recent article by Takei et al., which proposed the velocity ratio (VR) as the most reliable intraoperative echocardiographic indicator for bilateral pulmonary artery banding (BPAB). While this study represents a valuable step toward standardization, its heavy reliance on VR risks overlooking crucial hemodynamic variables. Drawing upon previous literature, this commentary highlights methodological limitations, clinical implications, and the necessity of integrating multiple echocardiographic and hemodynamic parameters. We advocate for a more comprehensive approach that ensures both systemic and pulmonary circulatory stability in congenital heart disease patients.