Pulmonary artery banding

Provided by "Pediatric Heart Surgery — a reference for professionals"

Pathophysiology

The pulmonary artery band procedure is a palliative surgical procedure that is used to restrict blood flow to the pulmonary artery. Pulmonary artery banding is performed in neonates or small infants with congenital heart disease who have excessive pulmonary blood flow. Patients submitted for this procedure might include patients with single ventricular anatomy in whom corrective surgery (staged Fontan) is not possible until later in life, or patients with multiple VSDs in whom complete repair can be more safely performed at a later age. Placement of a pulmonary artery band usually allows for better growth and development of infants who otherwise fail to thrive secondary to pulmonary overcirculation and congestive heart failure. When complete surgical repair presents inordinately high risk, pulmonary artery banding may offer therapeutic advantages.

Surgical technique

Pulmonary artery banding can be performed via median sternotomy or left thoracotomy. Cardiopulmonary bypass is not required for this procedure. First, a catheter is placed in the distal main pulmonary artery for pressure monitoring. Next, a band is placed around the main pulmonary artery and sutured into place. The band is then tightened with successive sutures until the pulmonary artery

pressure falls to 30 to 50 percent that of systemic pressure. Ideally there should not be a severe drop in peripheral arterial oxygen saturation, nor should there be a rise in right ventricular pressure to supra- systemic level. A significant drop in arterial oxygen saturation indicates that the pulmonary artery band is too restrictive and is causing right-to-left shunting of blood.

Postoperative considerations

Patients who undergo pulmonary artery band placement usually have a benign postoperative course. An arterial catheter is usually the only invasive monitor used following surgery. Vasoactive infusions are usually not required for postoperative hemodynamic management. Arterial oxygen saturation following pulmonary artery banding is usually 90% or higher. When pulmonary artery banding is performed for single ventricular lesions, arterial oxygen saturations may be lower. Postoperative bleeding, atrioventricular conduction disturbances, and hemodynamic instability are not commonly observed postoperative complications. Rarely, phrenic nerve injury is encountered, but this is usually transient. Length of hospital stay required following surgery averages 4 to 7 days, but may be longer depending on the degree of congestive heart failure and failure to thrive present before surgery.