Pulmonary Artery Banding Workup

  • Author: Shabir Bhimji, MD, PhD; Chief Editor: John Kupferschmid, MD   more...
 
Updated: Feb 28, 2012
 

Laboratory Studies

Routine laboratory tests are obtained preoperatively in the assessment of a patient being considered for pulmonary artery banding (PAB). Baseline arterial oxygen saturations should be obtained by either pulse oximetry or ABG analysis. A baseline creatinine level should be obtained and compared postoperatively during diuresis and management of congestive heart failure (CHF). The hemoglobin and hematocrit should be optimized to improve oxygen carrying capacity and oxygen saturations following pulmonary artery banding.

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Imaging Studies

  • Echocardiography
  • MRI with 3-dimensional reconstruction
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Diagnostic Procedures

  • Cardiac catheterization
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Contributor Information and Disclosures
Author

Shabir Bhimji, MD, PhD  Locum Cardiothoracic and Vascular Surgeon, Saudi Arabia and Middle East Hospitals

Shabir Bhimji, MD, PhD is a member of the following medical societies: American Cancer Society, American College of Chest Physicians, American Lung Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

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.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Mary C Mancini, MD, PhD  Professor and Chief of Cardiothoracic Surgery, Department of Surgery, Louisiana State University School of Medicine in Shreveport

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.

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.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors Mark D Plunkett, MD; Hillel Laks, MD; and Khanh Nguyen, MD to the development and writing of this article.

References

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The left anterior thoracotomy approach through the second or third intercostal space gives excellent exposure for isolated pulmonary artery banding. Note anatomy of the adjacent structures with medial limits of the incision at the internal mammary vessels. The thymus is swept superiorly away from the phrenic nerve. PA = pulmonary artery; PDA = patent ductus arteriosus.
Safe placement of a pulmonary artery band: (A) encircling the aortopulmonary trunk, (B) encircling the aorta, and (C) completing the pulmonary artery band at the final location.
Pulmonary artery banding technique (A-C) using a premeasured Trusler formula adjusted to the cardiac anatomy and physiology. An adjustable device is placed over a felt pledget with adventitial fixation sutures to prevent distal migration. Additional fixation sutures may be placed in the band itself. Each additional medium hemoclip causes approximately 1 mm of change in band circumference. Distal pulmonary artery pressure is measured during tightening.
Circumferential banding of a dilated pulmonary artery can acutely lead to internal infolding of the arterial wall. Later resorption of the infoldings and remodeling of the arterial wall restore a greater internal cross-sectional area.
Incisional pulmonary artery band yields a fixed reduction of 40% of the vessel diameter before application of a circumferential band.
(A) A partial Senning technique for improved mixing and saturation and providing both volume and afterload to the left ventricle after pulmonary artery banding. Autologous pericardium is used to baffle the inferior vena cava and the left pulmonary veins across the mitral valve into the left (pulmonary) ventricle, with superior vena cava and right pulmonary vein drainage to the systemic ventricle. The band is best positioned distally to avoid valvular damage in anticipation of the arterial switch procedure. (B) Pulmonary artery banding combined with a modified Blalock-Taussig shunt for rapid preparation of the left ventricle and the arterial switch procedure. This provides left ventricular volume and afterload and can be performed through a left lateral thoracotomy, avoiding the need for a resternotomy at the time of arterial switch. Careful measurement of the proximal pulmonary artery pressure is shown to avoid overtightening the band. PA = pulmonary artery.
Reconstruction of the pulmonary artery after band removal may be accomplished by patch arterioplasty using glutaraldehyde-treated autologous pericardium (A) or polytetrafluoroethylene (PTFE) material (B) or resection of the band site and end-to-end anastomosis using absorbable running sutures (C).
 
 
 
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