Pulmonary Artery Banding

Abstract

Ade-tailed analysis of 69 patients having undergone banding of the pulmonary artery is presented. The patients, all having a defect in the ventricular septum, were divided into 2 major groups. Group I consisted of 48 patients with a left-to-right intracardiac shunt, pulmonary artery hypertension, and normal great vessels. There was an over-all mortality of 19%. Since 1962, 24 of these patients have been subjected to this procedure with a mortality of only 8%. Group II consisted of 21 patients who, in addition to a left-to-right intracardiac shunt and pulmonary artery hypertension, had anomalies of the great vessels. The over-all mortality in this group was 81%. As a result of our review of these patients, certain statements can be made. Patients with a ventricular septal defect and a large left-to-right shunt, pulmonary artery hypertension, and no great vessel anomalies, in whom medical treatment has been unable to control congestive heart failure, have benefited significantly from the procedure. The risk of the surgery is definite but with improving technics and the use of constant pressure monitoring, this has been significantly reduced to a reasonable level during the past several years. If, in fact, as has been stated by others, there is no significant increase in morbidity or mortality at the time of total correction, it would appear, from clinical and hemodynamic measurements, that we are presenting for later definitive repair better surgical risk patients. For infants with intractable congestive heart failure due to a complete atrioventricular canal or a ventricular septal defect plus a patent ductus arteriosus, pulmonary artery banding is even more justified. In those patients who, in addition to a large left-to-right intracardiac shunt and pulmonary arterial hypertension, have great vessel anomalies, the risk of banding is much greater. Consequently, whenever possible, these patients should be treated conservatively. Surgical palliation is justified, at the present time, only as a last resort to prevent death rather than as a maneuver for an infant who fails to improve.