Clinical Application of Pulmonary Artery Banding_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LUO Xinjin , LI Qi , FANG Fang , YAN Jun , LI Shoujun , HU Shengshou , SHEN Xiangdong.

Department of Cardiovascular Surgery, Fu Wai Hospital, Peking Union Medical University &;
Chinese Academy of Medical Science, Beijing 100037, P. R. China;

Corresponding author：

Keywords：

Pulmonary artery banding; 　Congenital heart disease; 　Surgery

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Objective　To summarize our clinical experience of pulmonary artery banding （PAB） for the treatment of complex congenital heart diseases as a palliative procedure.?Methods?From January 1997 to November 2010, 138 patients with complex congenital heart diseases underwent PAB in Fu Wai Hospital. There were 87 male patients and 51　female patients with their age of 22.2±26.5 months and average body weight of 7.5±4.6 kg. All the 138 patients were divided into 3 groups according to the purpose of PAB：left ventricular retraining （group 1, n=55）, initial procedure for　functional single ventricle with unobstructed pulmonary blood flow （group 2, n=32） and initial palliative procedure followed　by later biventricular repair （group 3, n=51）. The intraoperative and postoperative clinical parameters of all participants were observed, and follow-up was made for these 3 groups of patients.?Results?The in-hospital mortality of PAB was 5.1% （7/138）. Three patients underwent re-banding procedure to adjust the size of banding. In group 1, there was 1 postoperative death. Among the 55 patients, 36 patients with dextro-transposition of great arteries received PAB at an average age of 19.6±29.5 months, 29 patients of whom underwent concomitant modified Blalock-Taussig shunt. After an average training interval for 42 days, 83.3% of them（30/36）successfully received arterial switch operation. The other 19 patients in group 1 with isolated corrected transposition of great arteries received PAB at an average age of 45.3±27.2 months. After
an average training interval for 9 months, 42.1% of them （8/19） successfully received double-switch operation. In group 2, there was 2 postoperative death. Thirty-two patients with functional single ventricle and unobstructed pulmonary blood flow received PAB at an average age of 14.1±14.9 months. Their　postoperative mean pulmonary artery pressure decreased significantly from 34.00±10.00 mm Hg to 23.00±7.40 mm Hg, and their oxygen saturation of blood （SpO2） significantly decreased from 92.60%±5.90% to 83.30%±6.30%. After a median interval of 2 years, 18.8% of them （6/32） underwent right heart bypass operation. In group 3, there was 4 postoperative death. Fifty-one patients received PAB at an average age of 20.60±25.60 months. After PAB procedure, the ratio of systolic pulmonary artery pressure and systolic blood pressure significantly decreased from 0.81±0.14 to 0.46±0.15, and their SpO2 significantly decreased from 93.10%±7.60% to 85.00%±10.00%. After a median interval of 6 months, 23.5% of them （12/51） received biventricular repair.?Conclusion
Although PAB is a palliative procedure with comparatively high risks, it still plays an indispensable role in terms of protecting pulmonary vascular beds, retraining ventricular function and two-stage surgical correction for the treatment of complex congenital heart diseases.

Citation： LUO Xinjin,LI Qi,FANG Fang,YAN Jun,LI Shoujun,HU Shengshou,SHEN Xiangdong.. Clinical Application of Pulmonary Artery Banding. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2012, 19(5): 489-493. doi: Copy

1.	Cardiovasc Surg， 2004， 127 （4）：975-981.
2.	Cardiol， 1987， 10 （2）：427-429.
3.	Muller WH Jr， Danimann JF Jr. The treatment of certain congenital malformations of the heart by the creation of pulmonic stenosis to reduce pulmonary hypertension and excessive pulmonary blood flow； a preliminary report. Surg Gynecol Obstet， 1952，95 （2）：213-219.
4.	Baslaim G. Modification of trusler′s formula for the pulmonary artery banding. Heart Lung Circ， 2009， 18 （5）：353-357.
5.	Takayama H， Sekiguchi A， Chikada M， et al. Mortality of pulmonary artery banding in the current era：recent mortality of PA banding. Ann Thorac Surg， 2002， 74 （4）：1219-1223.
6.	徐志伟，苏肇伉，丁文祥. 功能性单心室的外科治疗. 中国胸心血管外科临床杂志， 2002， 9 （2）：77-80.
7.	Valente AS， Mesquita F， Mejia JA， et al. Pulmonary artery banding：a simple procedure? A critical analysis at a tertiary center. Rev Bras Cir Cardiovasc， 2009，24 （3）：327-333.
8.	Lacour-Gayet F， Piot D， Zoghbi J， et al. Surgical management and indication of left ventricular retraining in arterial Switch for　transposition of the great arteries with intact ventricular septum. Eur J　Cardiothorac Surg， 2001， 20 （4）：824-829.
9.	徐志伟，苏肇伉，丁文祥，等. 快速二期动脉转位术纠治新生儿完全型大动脉转位. 中国胸心血管外科临床杂志， 2004， 11 （1）：12-15.
10.	Parker NM， Zuhdi M， Kouatli A， et al. Late presenters with dextro-transposition of great arteries and intact ventricular septum：to train or not to train the left ventricle for arterial switch operation? Congenit Heart Dis， 2009， 4 （6）：424-432.
11.	Metton O， Gaudin R， Ou P， et al. Early prophylactic pulmonary artery banding in isolated congenitally corrected transposition of the great arteries. Eur J Cardiothorac Surg， 2010， 38 （6）：728-734.
12.	Poirier NC， Yu JH， Brizard CP， et al. Long-term results of left ventricular reconditioning and anatomic correction for systemic right ventricular dysfunction after atrial Switch procedures. J Thorac.
13.	Winlaw DS， Mcguirk SP， Balmer C， et al. Intention-to-treat analysis of pulmonary artery banding in conditions with a morphological right ventricle in the systemic circulation with a view to anatomic biventricular repair. Circulation， 2005， 111 （4）：405-411.
14.	Quinn DW， Mcguirk SP， Metha C， et al. The morphologic left ventricle that requires training by means of pulmonary artery banding before the double-switch procedure for congenitally corrected transposition of the great arteries is at risk of late dysfunction. J Thorac Cardiovasc Surg， 2008， 135 （5）：1137-1144.
15.	Rodefeld MD， Ruzmetov M， Schamberger MS， et al. Staged surgical repair of functional single ventricle in infants with unobstructed pulmonary blood flow. Eur J Cardiothorac Surg， 2005， 27 （6）：949-955.
16.	Kajihara N， Asou T， Takeda Y， et al. Pulmonary artery banding for functionally single ventricles：impact of tighter banding in staged Fontan era. Ann Thorac Surg， 2010， 89 （1）：174-179.
17.	Baslaim G. Pulmonary artery banding：the tighter the better. Ann Thorac Surg， 2010， 90 （5）：1745-1746.
18.	Freedom RM. The dinosaur and banding of the main pulmonary trunk in the heart with functionally one ventricle and transposition of the great arteries：a saga of evolution and caution. J Am Coll.
19.	Cetta F， Boston US， Dearani JA， et al. Double outlet right ventricle：opinions regarding management. Curr Treat Options Cardiovasc Med， 2005， 7 （5）：385-390.
20.	Brown JW， Ruzmetov M， Okada Y， et al. Outcomes in patients with interrupted aortic arch and associated anomalies：a 20-year experience. Eur J Cardiothorac Surg， 2006， 29 （5）：666-673.
21.	Dhannapuneni RR， Gladman G， Kerr S， et al. Complete atrioventricular septal defect：outcome of pulmonary artery banding improved by adjustable device. J Thorac Cardiovasc Surg， 2011， 141 （1）：179-182.
22.	Brown S， Boshoff D， Rega F， et al. Dilatable pulmonary artery banding in infants with low birth weight or complex congenital heart disease allows avoidance or postponement of subsequent surgery. Eur J Cardiothorac Surg， 2010， 37 （2）：296-301.

1. Cardiovasc Surg， 2004， 127 （4）：975-981.
2. Cardiol， 1987， 10 （2）：427-429.
3. 　Muller WH Jr， Danimann JF Jr. The treatment of certain congenital malformations of the heart by the creation of pulmonic stenosis to reduce pulmonary hypertension and excessive pulmonary blood flow； a preliminary report. Surg Gynecol Obstet， 1952，95 （2）：213-219.
4. 　Baslaim G. Modification of trusler′s formula for the pulmonary artery banding. Heart Lung Circ， 2009， 18 （5）：353-357.
5. 　Takayama H， Sekiguchi A， Chikada M， et al. Mortality of pulmonary artery banding in the current era：recent mortality of PA banding. Ann Thorac Surg， 2002， 74 （4）：1219-1223.
6. 　徐志伟，苏肇伉，丁文祥. 功能性单心室的外科治疗. 中国胸心血管外科临床杂志， 2002， 9 （2）：77-80.
7. 　Valente AS， Mesquita F， Mejia JA， et al. Pulmonary artery banding：a simple procedure? A critical analysis at a tertiary center. Rev Bras Cir Cardiovasc， 2009，24 （3）：327-333.
8. 　Lacour-Gayet F， Piot D， Zoghbi J， et al. Surgical management and indication of left ventricular retraining in arterial Switch for　transposition of the great arteries with intact ventricular septum. Eur J　Cardiothorac Surg， 2001， 20 （4）：824-829.
9. 　徐志伟，苏肇伉，丁文祥，等. 快速二期动脉转位术纠治新生儿完全型大动脉转位. 中国胸心血管外科临床杂志， 2004， 11 （1）：12-15.
10. 　Parker NM， Zuhdi M， Kouatli A， et al. Late presenters with dextro-transposition of great arteries and intact ventricular septum：to train or not to train the left ventricle for arterial switch operation? Congenit Heart Dis， 2009， 4 （6）：424-432.
11. 　Metton O， Gaudin R， Ou P， et al. Early prophylactic pulmonary artery banding in isolated congenitally corrected transposition of the great arteries. Eur J Cardiothorac Surg， 2010， 38 （6）：728-734.
12. 　Poirier NC， Yu JH， Brizard CP， et al. Long-term results of left ventricular reconditioning and anatomic correction for systemic right ventricular dysfunction after atrial Switch procedures. J Thorac.
13. 　Winlaw DS， Mcguirk SP， Balmer C， et al. Intention-to-treat analysis of pulmonary artery banding in conditions with a morphological right ventricle in the systemic circulation with a view to anatomic biventricular repair. Circulation， 2005， 111 （4）：405-411.
14. 　Quinn DW， Mcguirk SP， Metha C， et al. The morphologic left ventricle that requires training by means of pulmonary artery banding before the double-switch procedure for congenitally corrected transposition of the great arteries is at risk of late dysfunction. J Thorac Cardiovasc Surg， 2008， 135 （5）：1137-1144.
15. 　Rodefeld MD， Ruzmetov M， Schamberger MS， et al. Staged surgical repair of functional single ventricle in infants with unobstructed pulmonary blood flow. Eur J Cardiothorac Surg， 2005， 27 （6）：949-955.
16. 　Kajihara N， Asou T， Takeda Y， et al. Pulmonary artery banding for functionally single ventricles：impact of tighter banding in staged Fontan era. Ann Thorac Surg， 2010， 89 （1）：174-179.
17. 　Baslaim G. Pulmonary artery banding：the tighter the better. Ann Thorac Surg， 2010， 90 （5）：1745-1746.
18. 　Freedom RM. The dinosaur and banding of the main pulmonary trunk in the heart with functionally one ventricle and transposition of the great arteries：a saga of evolution and caution. J Am Coll.
19. 　Cetta F， Boston US， Dearani JA， et al. Double outlet right ventricle：opinions regarding management. Curr Treat Options Cardiovasc Med， 2005， 7 （5）：385-390.
20. 　Brown JW， Ruzmetov M， Okada Y， et al. Outcomes in patients with interrupted aortic arch and associated anomalies：a 20-year experience. Eur J Cardiothorac Surg， 2006， 29 （5）：666-673.
21. 　Dhannapuneni RR， Gladman G， Kerr S， et al. Complete atrioventricular septal defect：outcome of pulmonary artery banding improved by adjustable device. J Thorac Cardiovasc Surg， 2011， 141 （1）：179-182.
22. 　Brown S， Boshoff D， Rega F， et al. Dilatable pulmonary artery banding in infants with low birth weight or complex congenital heart disease allows avoidance or postponement of subsequent surgery. Eur J Cardiothorac Surg， 2010， 37 （2）：296-301.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical Application of Pulmonary Artery Banding

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