Dilatable pulmonary artery banding in infants with low birth weight or complex congenital heart disease allows avoidance or postponement of subsequent surgery☆

Abstract

This study evaluated the efficiency and feasibility of dilatable bands in selected patients. Two types of dilatable handmade bands were retrospectively evaluated and divided into two groups: main pulmonary artery bands and bilateral branch pulmonary artery bands (hybrid stage I palliation). Stepwise balloon angioplasty (BA) was performed, increasing the diameter either to completely dilate with total release of the band, or in others, to partially dilate the bands in order to improve flow and/or saturation. Balloon angioplasty was performed in 20 patients (median birth weight 2.9 kg, range: 1.3-4.5 kg). Main pulmonary artery: Partial dilation: Six patients: Large ventricular septal defects (VSDs) and complex lesions requiring additional surgery. Progressive dilation allowed postponement of surgery in four children and allowed percutaneous VSD closure in one. Complete dilation: Eight patients: Spontaneous restriction of VSDs occurred in six patients; the bands were subsequently percutaneously completely released after a median of 39 weeks (7-91 weeks). The median gradient decreased from 90 to 38 mmHg (p<0.0001). Bilateral branch pulmonary artery: An average 8.5% increase in saturations was achieved in five patients, and in one patient, a hybrid procedure with borderline left ventricle, complete dilation allowed successful percutaneous biventricular repair. Dilation of both main and bilateral branch pulmonary artery bands is possible, effective and safe. Dilatable main pulmonary artery bands allow for progressive dilation with postponement of surgery or complete release of the bands. Bilateral dilatable branch pulmonary bands offer palliative benefit, especially in hybrid cases where pulmonary blood flow may be limited by the bands before the ideal conditions for a stage II procedure exist.