Pulmonary artery banding

Pulmonary artery banding

Pulmonary artery banding is used to reduce the pulmonary blood flow in situations of high pulmonary blood flow as a result of left to right shunts. Classical example is a large ventricular septal defect (VSD) where immediate surgical repair is not feasible. “Swiss cheese VSD” in which there are multiple muscular VSDs, adequate surgical repair may not be easy. Some of these defects may even have multiple right ventricular openings for a single left ventricular opening. When the surgical VSD closure is done from the right ventricle, when one VSD is closed, another one may be seen puffing from nearby. Pulmonary banding allows reduction of pulmonary blood flow to reasonable levels to prevent heart failure and development of irreversible obstructive pulmonary vascular disease. This permits growth of the baby and possible definitive repair at a later date. Balloon expandable pulmonary artery bands are now available, which can be deployed and balloon expanded at a later date when needed as the baby grows up.

Circumference of the band is calculated according to the Trussler rule: 20 mm + 1 mm/kg body weight.

Pulmonary artery banding in cyanotic congenital heart disease

Pulmonary artery banding (PA banding) can also be used in single ventricular physiologies like tricuspid atresia with large ventricular septal defect to reduce pulmonary blood flow and permit a more definitive procedure later in life. Another situation in which temporary PA banding is resorted to is for training the left ventricle in case of planned arterial switch operation in D-transposition of great arteries (D-TGA), beyond the usual time window. In general, arterial switch operation for D-TGA has to be performed within two to three weeks of life. Beyond that period, the left ventricle facing the pulmonary circulation regresses in musculature and will not be able to take up the function of future systemic pump after arterial switch operation. Depending on the period at which the arterial switch is performed, intra operative left ventricular training or two stage procedure can be planned. After an initial PA banding, when the left ventricular muscle is able to generate sufficient pressure to overcome the systemic vascular resistance, arterial switch operation is performed. PA band is removed after the definitive procedure. PA banding can also be considered prior to double switch operation for corrected transposition of great arteries (cTGA, also known as L-TGA, L-transposition of great arteries).

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