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J Thorac Cardiovasc Surg 2003;126:2104-2105
© 2003 The American Association for Thoracic Surgery

Letter to the editor

Chronic and adjustable pulmonary artery banding: reflections on old knowledge

Department for Cardiac Surgery, University of Luebeck, Ratzeberger Allee 160, Luebeck D-23538, Germany

To the Editor:

Leeuwenburgh and colleagues¹ presented an elegant article on their novel device for pulmonary artery banding. Some interesting characteristics of right ventricular "training" to sustain system pressures were reported 18 years ago^2,3 and may be of special interest for the development of pulmonary artery banding devices. Ideally, the aim of training of a right ventricle to sustain systemic load should prevent any kind of myocardial damage and probably imitate clinical conditions such as development of pulmonary stenosis. To imitate this type of continuous load increase, we developed and studied a novel device.² The results demonstrate that training of the right ventricle follows very delicate characteristics, at least in pigs.² We found that a fast pressure increase of 3.4 mm Hg/d during 3 weeks was associated with a 20% to 30% reduction in right ventricular ejection fraction and a 100% increase in right ventricular end systolic volume. On the other hand, a slow pressure increase of 1.5 to 2.2 mm Hg/d was associated with less significant functional impairment of the right ventricle. Thus pulmonary artery banding may have harmful effects, which might be even more complex in children with heart disease. Therefore open questions should be addressed before the proposed clinical application of this new device, such as the appropriateness of stepwise load increase in comparison to continuous load increase, with special reference to the implications for right ventricular function. It should also be discussed whether the new device includes refined mechanisms that allow for sensitive adjustment of load increase.

	References

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1. Leeuwenburgh BP, Schoof PH, Steendijk P, Baan J, Mooi WJ, Helbing WA. Chronic and adjustable pulmonary artery banding. J Thorac Cardiovasc Surg. 2003;125:231–237[Abstract/Free Full Text]
   
2. Lange PE, Sievers HH, Nürnberg JH, Engler K, Pilarczyk D, Onnasch DG, et al. A new device for slow progressive narrowing of vessels. Basic Res Cardiol. 1985;80:430–435[Medline]
   
3. Lange PE, Nürnberg JH, Sievers HH, Onnasch DG, Bernhard A, Heintzen PH. Response of the right ventricle to progressive pressure loading in pigs. Basic Res Cardiol. 1985;80:436–444[Medline]
   

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Sievers, H. H. Search for Related Content PubMed PubMed Citation Articles by Sievers, H. H. Related Collections Congenital - acyanotic Related Article