Pulmonary Artery Banding

Excerpt

Pulmonary artery banding (PAB) is a surgical technique used for the palliation of certain congenital cardiac defects. The most common indication is for the limitation of pulmonary blood flow in the clinical scenario of pulmonary over-circulation caused by large left-to-right shunts. In the early era of congenital heart palliation prior to routine definitive repair, PA banding was often used as the initial surgical intervention in some children with certain cardiac defects. However, given the advances in surgical techniques and improved surgical outcomes of primary definitive repair in the current era, PAB has been reserved for palliation in a certain subset of infants with complex congenital heart defects.

The physiologic purpose of a PAB is to protect the pulmonary vasculature by reducing excessive pulmonary blood flow and restricting the pressure load to the pulmonary bed, thereby preventing pathologic remodeling of the pulmonary vasculature and pulmonary hypertension. In other patients, the physiologic intent of a PAB differs slightly and is intended to "train" the left ventricle in preparation for a staged arterial switch procedure. This is the case in patients who may be undergoing complex reconstruction that requires "training" of a ventricle prior to functioning as a systemic ventricle. More specific examples of each of these scenarios are further described below.

Muller and Dammann performed the first PAB in 1951 in a 5-month old infant with a large ventricular septal defect (VSD) and a large left-to-right shunt with pulmonary over circulation. Subsequently, multiple studies demonstrated the effectiveness of PAB in patients with congestive heart failure secondary to tricuspid atresia, large VSDs, and atrioventricular canal defects (AVC). Despite the decline in the use of PAB by cardiac surgeons, it remains an essential surgical technique in the armamentarium of surgeons for the comprehensive treatment of complex congenital heart defects.