Debanding and repair of ventricular septal defect: a new technique for older patients

Between October 1972 and April 1977 15 patients underwent definitive repair of a ventricular septal defect (VSD) and reconstruction of the pulmonary artery at the banding site. This report presents pre- and post-operative haemodynamic data in 12 patients, seven to 22 years after banding (mean 13.4). Banding of the pulmonary artery was performed before the age of 6 months (mean 4). The indications were increased pulmonary blood flow and intractable heart failure. As we had previously become dissatisfied with patch angioplasty of the main pulmonary artery, we introduced a new technique in this group of excising the site of the band and anastomosing the pulmonary artery end-to-end. The gradient between the right ventricle and pulmonary artery was abolished completely in nine cases and reduced to below 30 mmHg in the remaining three patients. This technique is used only in older patients in whom the banding has persisted for a long time. In children under 2 years of age we usually remove the band and dilate the pulmonary artery.