Case Report: Pulmonary artery banding for an older child with end-stage dilated cardiomyopathy

Therapeutic options for children with end-stage dilated cardiomyopathy are limited. Pulmonary artery banding has been proposed as a potential bridge or alternative strategy in children with severe left ventricular dysfunction and preserved right ventricular function, but related experience in older children is limited. We report a 5.5-year-old girl diagnosed with dilated cardiomyopathy who showed progressive left ventricular dilation and persistent systolic dysfunction despite long-term medical therapy. Preoperative echocardiography showed left ventricular end-diastolic diameter (LVEDD) of 64.4 mm, Z-score of +9.7, and left ventricular ejection fraction (LVEF) of 25.0%, while cardiac magnetic resonance imaging (CMR) demonstrated relatively preserved right ventricular systolic function. Pulmonary artery banding was performed without major perioperative complications. At 4-month follow-up, her clinical symptoms improved from NYHA class II to class I; however, echocardiography showed persistent reverse remodeling, with an LVEF of 25.7% and an LVEDD Z-score of +8.8. This case suggests that PAB may provide symptomatic benefit in older children with end-stage DCM but that delayed intervention may limit myocardial recovery.