Fenestrated PECA exGraft Patch as a Novel Modifiable Internal Pulmonary Artery Band: A Case Report

Pulmonary overcirculation in single-ventricle physiology often requires early modulation to preserve systemic output while balancing the timing and risk of surgical palliation. We report the first use of a fenestrated balloon-expandable PECA exGraft patch as a modifiable intraluminal pulmonary artery band (IL-PAB). A full-term neonate with heterotaxy syndrome, complex anatomy with borderline left ventricle, ductal-dependent systemic circulation, and primary ciliary dyskinesia developed severe pulmonary overcirculation with respiratory instability, making early surgery prohibitive. Initial transcatheter pulmonary flow restrictor placement achieved hemodynamic stabilization. At 8 weeks of age, during aortic arch repair, a fenestrated PECA exGraft IL-PAB was implanted in the main pulmonary artery. Progressive restriction with somatic growth was subsequently treated by transcatheter balloon dilation of the graft fenestration, resulting in improved oxygenation and reduced gradient. This case demonstrates the feasibility of a staged and catheter-modifiable strategy for pulmonary blood flow regulation using an expandable internal pulmonary artery band in high-risk infants requiring adaptable physiologic control.