Pulmonary artery banding in congenital heart disease associated with pulmonary hypertension

Abstract

A report is presented of pulmonary artery banding in 45 children with congenital heart disease associated with severe pulmonary hypertension. The majority were in uncontrollable heart failure and were in the age group 3 to 18 months. Nine older children not in 'heart failure were operated on because of serious pulmonary hypertension associated with malformations considered unsuitable for complete repair (truncus arteriosus, single ventricle). The mortality in those with uncomplicated ventricular septal defect was low (5.5%), but was much higher in those with accompanying lesions or more complex abnormalities (63% months, and the eldest of the remaining eight was 10 years. The majority were infants and very young children who had congestive cardiac failure accompanying pulmonary hypertension at or close to systemic level not fully responsive to digitalization and intensive diuretic therapy, and who were not thriving and unlikely to survive early childhood. By contrast the older children were not acutely ill but had exertional dyspnoea, radiographic evidence of cardiac enlargement, and pulmonary hypertension ranging from 75/0 to 160/20 mm. Hg. The reason for not carrying out a complete repair of their cardiac lesions in preference to pulmonary artery banding will be discussed later. Table I presents details of a diagnostic classification related to death at operation and survival. The diagnosis was made by cardiac catheterization and angiocardiography and was confirmed at either operation or necropsy. RESULTS GROUP 1 These patients had a ventricular septal defect with pulmonary hypertension and no other abnormality. The group comprised 18 of our 45 patients, and their ages ranged from 3 months to 9 years. With the exception of three children aged respectively 3, 8, and 9 years, the remainder were 17 months or younger and were admitted with severe congestive cardiac failure and failure to thrive. As intensive medical management failed to alleviate their symptoms, full cardiac investigation was undertaken. 385 2G on 11 May 2018 by guest. Protected by copyright.

Pulmonary hypertension accompanying ventricular septal defect and patent ductus arteriosus. Management in infancy and early childhood.

“…For many years the recommended procedure for infants with intractable cardiac failure associated with a large VSD with pulmonary hypertension was pulmonary artery banding, followed in later childhood by repair of the defect and pulmonary artery reconstruction (Muller and Damman, 1952;Hallman et al, 1966;Reid et al, 1968;Stark et al, 1969;Coleman et al, 1972). This procedure has now been superseded in large measure by primary repair of the defect in infancy when indicated (Cartmill et al, 1966;Yasui et al, 1977;Fox et al, 1978).…”

Progress report on infants with serious cardiac malformations.

“…Their clinical improvement was probably attributable at least in part to spontaneous narrowing of the ventricular septal defect. Intractable congestive cardiac failure associated with a ventricular septal defect and pulmonary hypertension is an indication for pulmonary artery banding, but where there is a large atrial septal defect in addition, operation carries a greater risk and benefit resulting from it is less assured (Reid et al, 1968).…”