Closure of ventricular septal defect and removal of pulmonary arterial band: Results in eight children

Abstract

In a series of 8 patients pulmonary arterial banding was performed in infancy for large ventricular septal defect, and the defect was later operatively closed and the band removed. Hemodynamic evaluation was performed before banding, before corrective surgery and again at least 6 months after closure of the ventricular septal defect and removal of the pulmonary band. The hemodynamic data revealed successful closure of the ventricular septal defect in all cases. The pulmonary vascular resistance was at nearly normal levels in 3 patients, moderately increased in 4 and markedly increased in only the single patient banded late. As a consequence of the band, right ventricular or pulmonary outflow obstruction developed in 6 of the patients but was a significant problem in only 1 patient. Iatrogenic complications directly related to the presence of a pulmonary band are presented. Thickening of pulmonary valvular cusps with acquired secondary pulmonary valvular stenosis, although mild, occurred in 7 patients. Acquired infundibular pulmonary stenosis was also noted in 3 but was not of any hemodynamic significance. Some of these complications may be related to proximity of the band to the valve annulus. Despite these potential acquired complications, pulmonary arterial banding is considered a significant palliative procedure in the total treatment of excessive pulmonary blood flow and pulmonary hypertension.