eMedicine Specialties > Pediatrics: Cardiac Disease and Critical Care Medicine > Cardiothoracic Surgery

Pulmonary Artery Banding: Follow-up

Author: Mark D Plunkett, MD, Associate Professor of Surgery, Frank C Spencer Chair of Surgery, University of Kentucky College of Medicine; Chief, Division of Cardiothoracic Surgery, Director of Pediatric Cardiothoracic Program, University of Kentucky Children's Hospital
Coauthor(s): Hillel Laks, MD, Professor and Chief, Division of Cardiothoracic Surgery, University of California at Los Angeles Medical Center; Khanh Nguyen, MD, Assistant Professor, Department of Cardiothoracic Surgery, Mount Sinai School of Medicine; Chief of Pediatric Cardiac Surgery, Department of Surgery, Mount Sinai Medical Center
Contributor Information and Disclosures

Updated: Apr 23, 2009

Outcome and Prognosis

Pulmonary artery banding (PAB) should result in improved hemodynamics and overall clinical improvement in the patient. The signs and symptoms of congestive heart failure (CHF) should resolve or become medically manageable, cardiomegaly should decrease, and the pulmonary vascular resistance should decrease. Pulmonary artery banding affords protection to the pulmonary vasculature against fixed irreversible pulmonary hypertension secondary to pulmonary overcirculation and elevated pulmonary artery (PA) pressures.

The mortality rate of pulmonary artery banding is clearly associated more with the complexity of the cardiac defect and the overall condition of the patients than with the procedure itself. Patients who are selected for pulmonary artery banding and a staged repair are often chosen because they are considered too high risk to undergo definitive repair. Therefore, the mortality rates from earlier series have been as high as 25%.53 A decreasing mortality rate with pulmonary artery banding can be related to improved operative techniques and better patient selection and timing of intervention.54,55,56,57 Additionally, improvements in anesthetic and postoperative management have also resulted in a decreased mortality rate. Current mortality rates for pulmonary artery banding are reported in some series to be as low as 3-5%.

Future and Controversies

Almost half a century since the introduction of pulmonary artery banding (PAB) by Muller and Dammann, this procedure still has a defined role in the treatment of infants who are not candidates for immediate definitive repair. In particular, it may be useful in patients with a functional single ventricle not amenable to early repair and in whom a future Fontan procedure is planned. It may also benefit patients with excessive pulmonary blood flow who are considered too ill to undergo complete repair of their cardiac defect. Interestingly, the original technique of an incisional band as described by Muller and Dammann has resurfaced as a desirable technique in some patients.

The adjustable band technique has proved useful and safe for most patients. Interest has been shown for the development of an intraluminal technique for pulmonary artery banding using circular patches of fenestrated material.58 This requires a cardiopulmonary bypass to perform and is therefore limited in its applicability to most patients. Ongoing research to develop a percutaneously adjustable, thoracoscopically implantable, pulmonary artery band is underway.59

Additionally, research is being conducted in animals to develop a hydraulic main pulmonary artery (MPA) constrictor as an adjustable pulmonary artery banding.60 These types of devices would benefit patients who require multiple adjustments of a PAB for left ventricle (LV) training. An implantable device for pulmonary artery banding with telemetric control, FloWatch-R-PAB (Endoart SA, Lausanne, Switzerland) has emerged from animal studies and is currently in clinical trials.61,62 Early clinical results have shown the efficacy and reliability of the device, but more data and experience are needed to define the role of this technology in PAB.

For most patients undergoing pulmonary artery banding, the goal of the procedure remains the reduction of pulmonary blood flow (PBF) and the preservation of the pulmonary vessels from hypertrophy and hypertension. More recently, a new indication of preparing the LV for arterial switch in older infants and children with D-transposition of the great arteries (TGA) appears to have expanded the role of this procedure. Although some surgeons would contend that pulmonary artery banding is largely of historical interest, this technique clearly will continue to maintain a place in the therapeutic armamentarium of the congenital heart surgeon.

 


More on Pulmonary Artery Banding

Overview: Pulmonary Artery Banding
Workup: Pulmonary Artery Banding
Treatment: Pulmonary Artery Banding
Follow-up: Pulmonary Artery Banding
Multimedia: Pulmonary Artery Banding
References
Further Reading
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References

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Keywords

pulmonary artery banding, PA banding, PAB, congenital heart disease, pulmonary hypertension, D-transposition of the great arteries, D-TGA, delayed arterial switch procedure, pulmonary blood flow, PBF, diagnosis, treatment, transposition of the great arteries, arterial switch, ventricular septal defect, VSD, tricuspid atresia, atrioventricular canal defects, pulmonary hypertension, congestive heart failure, ventricular septal defect, main pulmonary artery, MPA, diagnosis, treatment, hypoplastic left heart syndrome, HLHS

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Contributor Information and Disclosures

Author

Mark D Plunkett, MD, Associate Professor of Surgery, Frank C Spencer Chair of Surgery, University of Kentucky College of Medicine; Chief, Division of Cardiothoracic Surgery, Director of Pediatric Cardiothoracic Program, University of Kentucky Children's Hospital
Mark D Plunkett, MD is a member of the following medical societies: American College of Surgeons, American Heart Association, American Medical Association, International Society for Heart and Lung Transplantation, New York Academy of Sciences, and Society of Thoracic Surgeons
Disclosure: Nothing to disclose.

Coauthor(s)

Hillel Laks, MD, Professor and Chief, Division of Cardiothoracic Surgery, University of California at Los Angeles Medical Center
Hillel Laks, MD is a member of the following medical societies: American Association for Thoracic Surgery, American College of Angiology, American College of Cardiology, American College of Chest Physicians, American College of Surgeons, American Federation for Clinical Research, American Heart Association, American Medical Association, American Society for Artificial Internal Organs, American Surgical Association, Congenital Heart Surgeons Society, International Society for Heart and Lung Transplantation, Pan-Pacific Surgical Association, Society of Thoracic Surgeons, Society of University Surgeons, and Western Thoracic Surgical Association
Disclosure: Nothing to disclose.

Khanh Nguyen, MD, Assistant Professor, Department of Cardiothoracic Surgery, Mount Sinai School of Medicine; Chief of Pediatric Cardiac Surgery, Department of Surgery, Mount Sinai Medical Center
Disclosure: Nothing to disclose.

Medical Editor

Jonah Odim, MD, PhD, MBA, Senior Medical Officer, Transplantation Immunology Branch, Division of Allergy, Immunology, and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health
Jonah Odim, MD, PhD, MBA is a member of the following medical societies: American College of Cardiology, American College of Chest Physicians, American College of Physician Executives, American College of Surgeons, American Heart Association, American Society for Artificial Internal Organs, American Society of Transplant Surgeons, Association for Academic Surgery, Association for Surgical Education, Canadian Cardiovascular Society, International Society for Heart and Lung Transplantation, National Medical Association, New York Academy of Sciences, Royal College of Physicians and Surgeons of Canada, Society of Critical Care Medicine, and Society of Thoracic Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Mary C Mancini, MD, PhD, Professor, Department of Surgery, Louisiana State University Health Sciences Center
Mary C Mancini, MD, PhD is a member of the following medical societies: American Association for Thoracic Surgery, American College of Surgeons, American Surgical Association, Phi Beta Kappa, Society of Thoracic Surgeons, and Southern Surgical Association
Disclosure: Nothing to disclose.

CME Editor

Daniel Rauch, MD, FAAP, Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine
Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine
Disclosure: Baxter Honoraria Consulting

Chief Editor

John Kupferschmid, MD, Director of Congenital Heart Surgery, Department of Surgery, Methodist Children's Hospital at San Antonio
John Kupferschmid, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, Society of Thoracic Surgeons, and Society of Thoracic Surgeons
Disclosure: Nothing to disclose.

 
 
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