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J Thorac Cardiovasc Surg 2003;125:231-237
© 2003 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease (CHD)

Chronic and adjustable pulmonary artery banding

From the Departments of Pediatrics (Pediatric Cardiology),^a Cardiology (Cardiac Physiology Laboratory),^b and CardioThoracic Surgery,^c Leiden University Medical Center, Leiden, Department of Pathology,^d The Netherlands Cancer Institute, Amsterdam, and the Department of Pediatrics (Pediatric Cardiology),^e Erasmus Medical Center—Sophia Children's Hospital, Rotterdam, The Netherlands.

This study was financially supported by a grant from the Gisela Thier foundation, Leiden, The Netherlands, and the department of Pediatrics, Leiden University Medical Center.

Received for publication Dec 28, 2001. Revisions requested March 26, 2002; revisions received April 3, 2002. Accepted for publication June 14, 2002. Address for reprints: J. Baan, PhD, Department of Cardiology, C5-P, Leiden University Medical Center, PO Box 9600, 2300 RC, The Netherlands (E-mail: J.Baan{at}lumc.nl).

Objective: Banding of the pulmonary artery might be required to prevent pulmonary vascular damage in patients with increased pulmonary artery flow and to retrain the left ventricle in preparation for an arterial switch operation in patients with congenitally corrected transposition of the great arteries. Readjustment of the pulmonary artery band might be required in the postoperative period. In this study we aimed to test the feasibility of a novel device for bidirectionally adjustable pulmonary artery constriction.
Methods: A hydraulic main pulmonary artery occluder was implanted in lambs and gradually inflated to create right ventricular pressure overload at a systemic (aortic) level. During the following period (up to 12 weeks), this pressure overload was monitored by measuring aortic and right ventricular pressures by means of implanted subcutaneous reservoirs. If required to maintain the right ventricular pressure overload at a systemic level in the growing animals, the occluder was deflated through a third subcutaneous reservoir.
Results: After the banding period (average of 64 ± 8 days), the main pulmonary artery cuff could still be adjusted, and the animals showed no clinical signs of heart failure. Histologic analysis of the pulmonary artery showed extensive fibrosis, a giant cell response around the device, and small areas of tissue necrosis; complete transmural necrosis was not detected.
Conclusions: This device allows adjustment of the pulmonary artery cuff in a precise manner over a prolonged period of time without surgical reintervention. Potentially, the device might have applications for clinical use in children with congenital heart disease.

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