Utility of late pulmonary artery banding in single-ventricle physiology: A mid-term follow-up
Open Access
- 1 January 2021
- journal article
- research article
- Published by Medknow in Annals of Pediatric Cardiology
- Vol. 14 (1), 26-34
- https://doi.org/10.4103/apc.APC_128_20
Abstract
Background: The standard first stage palliation for univentricular heart with unrestricted pulmonary blood flow (PBF) is surgical pulmonary artery (PA) banding for which the ideal age is within the first 8 weeks of life. This study aimed to look for the utility of PA band done beyond 3 months of age for patients presenting beyond the stipulated period. Materials and Methods: This is a retrospective analysis of the outcome of twenty patients with single ventricle (SV) physiology with unrestricted PBF who presented late and were selected on the basis of clinical, radiological, and echocardiographic parameters for PA banding. Results: The median age of the patients was 5.5 months (3.5-96 months), and the median body weight was 4.7 kg (3.2-22.0 kg). The patients were divided into three groups as follows: ten patients between 3 and 6 months of age (Group A), seven patients between 6 months to 1 year of age (Group B), and three patients > 1 year of age with additional features of pulmonary venous hypertension (Group C). The mean reduction of PA pressures following PA band was 60.9%, 48.8%, and 58.3% and the mean fall in oxygen saturation was 10.4%, 8.0%, and 6.6% in the three groups, respectively. The postoperative mortality rate was 10%. The mean follow up duration was 13.5 months (7-23 months). There was a statistically significant improvement in weight for age Z scores following PA band (P = 0.0001). On follow up cardiac catheterization, the mean PA pressures were 16.6 (+/- 3.6), 22.7 (+/- 5.7), and 33.3 (+/- 12.4) mmHg, respectively, in the three groups, and the mean pulmonary vascular resistance index was 1.86 (+/- 0.5), 2.45 (+/- 0.7), and 3.5 (+/- 1.6) WU.m2, respectively. Subsequently, seven patients in Group A, three patients in Group B, and one patient from Group C underwent successful bidirectional Glenn (BDG) surgery. Conclusions: Late PA band in selected patients with SV physiology can have definite benefit in terms of correction of heart failure symptoms and subsequent conversion to BDG and can potentially change the natural history of disease both in terms of survival and quality of life.Keywords
This publication has 26 references indexed in Scilit:
- Management of the single ventricle and potentially obstructive systemic ventricular outflow tractJournal of the Saudi Heart Association, 2013
- Pulmonary artery banding in the current era: Is it still useful?Annals of Pediatric Cardiology, 2012
- Pulmonary Hypertension Related to Left-Sided Cardiac PathologyPulmonary Medicine, 2011
- Presentation, survival prospects, and predictors of death in Eisenmenger syndrome: a combined retrospective and case-control studyEuropean Heart Journal, 2006
- Staged surgical repair of functional single ventricle in infants with unobstructed pulmonary blood flowEuropean Journal of Cardio-Thoracic Surgery, 2005
- Time course of changes in pulmonary vascular resistance and the mechanism of regression of pulmonary arterial hypertension after balloon mitral valvuloplastyThe American Journal of Cardiology, 1991
- Pulmonary Artery Banding: Analysis of a 25-Year ExperienceThe Annals of Thoracic Surgery, 1989
- Pulmonary Artery Banding RevisitedAnnals of Surgery, 1989
- Pulmonary Artery Banding: Results and Current Indications in Pediatric Cardiac SurgeryThe Annals of Thoracic Surgery, 1987
- PULMONARY HYPERTENSION WITH SPECIAL REFERENCE TO THE VASOCONSTRICTIVE FACTORHeart, 1958