Pulmonary Artery Banding in Post-tricuspid Congenital Cardiac Shunting Defects with High Pulmonary Vascular Resistance

Kulik, Thomas J.; McSweeney, Julia; Tella, Joseph B; Mullen, Mary P.

doi:10.1007/s00246-019-02054-x

Cited by 4 publications

(4 citation statements)

References 19 publications

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“…PAB can physically reduce the pressure load on the periphery of the PA, and may support “reverse remodeling” of pulmonary hypertensive lesions of the PA vasculature [ 2 , 4 ]. Although the usefulness of PAB for the treat-and-repair strategy in VSD remains controversial [10] , it was effective for reducing the hemoptysis risk during DTT combination therapy in this case.…”

Section: Discussionmentioning

confidence: 81%

“…This pathophysiology is closely related to the difficulty of PAH treatment in patients with VSD-PAH. Systolic PAP must remain unchanged even if PVR decreases due to DTT in patients with VSD [10] . Therefore, treatment with DTT could easily cause hemoptysis and/or heart failure.…”

Section: Discussionmentioning

confidence: 99%

“…This treat-and-repair for VSD-PAH is still a challenging strategy and should be applied for only limited patients with careful informed consent. Fourth, because a risk of a progressive increase in PVR may be present, even several years after VSD closure [10] , careful and long-term observation is required to determine the real efficacy of this strategy.…”

Section: Discussionmentioning

confidence: 99%

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A case of a middle-aged patient with a ventricular septal defect complicated by severe pulmonary hypertension-stepwise surgical repair with pulmonary vasodilators-

Kanai

Koitabashi

Akagi

et al. 2021

Journal of Cardiology Cases

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We report a case of ventricular septal defect (VSD) in which we attempted to treat pulmonary arterial hypertension (PAH) with the goal of VSD closure in an adult with suspected Eisenmenger syndrome in childhood. Four years previously (age 41 years), she was referred to our department due to repeated hemoptysis requiring further treatment of PAH. We started combination therapy with several pulmonary vasodilators. Two years later, her pulmonary vascular resistance (PVR) was improved but still not at the level where VSD closure was possible. To control the increased PA flow resulting from intensive PAH treatment and to reduce the risk of hemoptysis, we performed pulmonary artery banding (PAB). As the risk of hemoptysis decreased, a prostacyclin analog was introduced, and the dose was increased. More than 1 year after PAB, active vasoactivity testing became positive, suggesting that the pulmonary vascular lesion was now "reversible". We performed VSD closure and atrial septal defect creation even though her PVR was still high. After the operation, her exercise capacity was remarkably improved. We suggest that stepwise surgical repair with pulmonary vasodilators is an important treatment option for select patients with VSD with severe PAH. Learning objective Advances in pulmonary arterial hypertension (PAH) treatment have led to the use of a "treat-and-repair" strategy to close the intracardiac shunt after PAH treatment in select patients with adult congenital heart disease. In our case, ventricular septal defect (VSD) closure was achieved with stepwise surgical repair and a combination of pulmonary vasodilators, even though long-standing severe PAH with persistent hemoptysis remained. Even after a long period of exposure to high blood flow, this strategy may reduce pulmonary vascular resistance and permit eventual closure of the VSD.

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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A case of a middle-aged patient with a ventricular septal defect complicated by severe pulmonary hypertension-stepwise surgical repair with pulmonary vasodilators-

Kanai

Koitabashi

Akagi

et al. 2021

Journal of Cardiology Cases

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“…However, the variation in the oxygen saturation is resulted from incomplete venous mixing, making RA a poor choice to truly estimate oxygen saturation. Therefore, the dependence on the results of only one or two samples to estimate oxygen increase is highly susceptible to error [ 8 , 9 ]. On the other hand, the variability in PA measurement is always attributed to inherited measurement errors.…”

Section: Discussionmentioning

confidence: 99%

Detecting and Quantifying Residual Intracardiac Shunts Using Oximetric Step-Up Methods: A Prospective Observational Study

Bhende¹,

Sharma²,

Sharma³

et al. 2023

Cureus

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Background & aims Intracardiac shunts are abnormal channels of blood circulation within the heart that develop either as an additional blood flow pathway or as a replacement for the normal channels of blood circulation. They are the commonest types of congenital heart defects. Various methods are available in the present times to identify, localize or quantify left-to-right intracardiac shunts. Methods may vary in sensitivity, indicators, or types of equipment available. One such method used in almost all cardiac centers for a long time has been oximetry run to detect step-up differences in oxygen saturation values. In the oximetry run the main approach to detect and estimate the left-to-right (L-->R) shunts requires the oxygen concentration expressed as a proportion of saturation to be evaluated in blood samples which are obtained from the right atrium (RA) and pulmonary artery (PA), respectively. A left-to-right shunt can be considered if there is a significant increase (step-up) in blood saturation. A significant step-up is defined as a substantial rise in blood oxygen content or saturation that is higher than normal values. Methods Using a prospective observational design, this article investigates the application of the step-up method in detecting intracardiac shunts. The study was conducted between 2021 and 2022 on 35 pediatric cardiac patients (males/females, 24/11) diagnosed with post-tricuspid shunts. The pulmonary artery and right atrium were sampled before and after cardiopulmonary bypass surgery and analyzed using a blood gas test. As a result, nearly 91% of the patients had a saturation below 8%. However, the difference between PA oxygen saturation (SO 2) & RASO 2 before and after surgery was significant. As a result, the difference in O 2 saturation helped detect the residual ventricular septal defect (VSD) after the surgery. Results There were no deaths or complications in this study. There were no re-interventions for post-tricuspid shunt surgery, though one patient had a step-up of >15% and residual VSD status was moderate to large on two-dimensional (2D) echocardiography. Conclusion A combination of physical findings, chest radiography, electrocardiogram (ECG), and echocardiography is routinely done for all these patients undergoing pediatric cardiac surgery. Echocardiography can detect the occurrence of shunt but does not calculate the shunt ratio. Transesophageal or epicardial echocardiography is the standard of care but has its limitations like perception difference between the operating surgeon and the person performing echocardiography. In this study, we have added an oximetry analysis of blood-gas samples before and after surgery and compared it to 2D echocardiography to test the validation of oximetry in isolation and comparison to 2D echocardiography.

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Pulmonary Hypoplasia Resulting from Pulmonary Artery Banding in Infancy: A Neonatal Rat Model Study

Luo

et al. 2020

Pediatr Cardiol

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Pulmonary Artery Banding in Post-tricuspid Congenital Cardiac Shunting Defects with High Pulmonary Vascular Resistance

Cited by 4 publications

References 19 publications

A case of a middle-aged patient with a ventricular septal defect complicated by severe pulmonary hypertension-stepwise surgical repair with pulmonary vasodilators-

A case of a middle-aged patient with a ventricular septal defect complicated by severe pulmonary hypertension-stepwise surgical repair with pulmonary vasodilators-

Detecting and Quantifying Residual Intracardiac Shunts Using Oximetric Step-Up Methods: A Prospective Observational Study

Pulmonary Hypoplasia Resulting from Pulmonary Artery Banding in Infancy: A Neonatal Rat Model Study

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