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Vitaly V. Piluiko
Hassan Nemeh
Ralph E. Delius
Henry L. Walters, III
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J Thorac Cardiovasc Surg 2005;129:544-550
© 2005 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Efficacy of intraluminal pulmonary artery banding

Vitaly V. Piluiko, MDa, Jeffrey A. Poynter, BSa, Hassan Nemeh, MDb, Ronald L. Thomas, PhDc, Thomas J. Forbes, MDd, Ralph E. Delius, MDa, Henry L. Walters, III, MDa,*

a Department of Cardiovascular Surgery
d Division of Pediatric Cardiology,
c Children's Research Center of Michigan, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Mich
b Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, Ill

Read at the Thirtieth Annual Meeting of The Western Thoracic Surgical Association, Maui, Hawaii, June 23-26, 2004.

Received for publication July 12, 2004; revisions received August 21, 2004; accepted for publication August 25, 2004.

* Address for reprints: Henry L. Walters III, MD, Department of Cardiovascular Surgery, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201 (E-mail: hwalters{at}dmc.org).

OBJECTIVE: The extraluminal technique of pulmonary artery banding can be difficult to perform precisely in conjunction with cardiopulmonary bypass and is associated with a significant risk of band-related complications. We analyzed our results with an intraluminal technique of pulmonary artery banding in patients who required cardiopulmonary bypass for the performance of associated cardiac repairs.

METHODS: The medical records of 18 neonates and infants who underwent intraluminal pulmonary artery banding were retrospectively reviewed. A circular patch with a 3.0-mm, 3.6-mm, or 4.0-mm diameter fenestration was sutured to the inner circumference of the main pulmonary artery. Preoperative, intraoperative, and postoperative variables were reviewed to assess the efficacy and safety of the intraluminal technique.

RESULTS: Intraluminal pulmonary artery banding produced a consistent and significant reduction in the systolic pulmonary artery pressure (64.00 ± 12.24 to 16.53 ± 6.33 mm Hg, P < .001), the systolic pulmonary artery pressure/systolic systemic pressure ratio (0.91 ± 0.10 to 0.19 ± 0.07, P < .001), and the pulmonary flow/systemic flow ratio (4.32 ± 3.04 to 0.91 ± 0.49, P = .015). There were no band-related anatomic complications. Two patients did require percutaneous dilation of the intraluminal pulmonary artery band before debanding to palliate systemic arterial desaturation.

CONCLUSIONS: Intraluminal pulmonary artery banding is an effective palliative procedure that can be used in patients who require cardiopulmonary bypass for the performance of cardiac repairs in addition to placement of the pulmonary artery band.




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