Pulmonary Artery Banding -Original, Current, and New Indications for Pulmonary Artery Banding-

Abstract

First performed in the early 1950s in children with a large left-to-right shunt or single ventricle and excessive pulmonary blood flow, pulmonary artery banding (PAB) is a palliative surgery designed to relieve symptoms. After advances in cardiopulmonary bypass techniques in the 1980s allowed surgeons to perform corrective surgery even in infants, PAB has continued to play a palliative role in balancing the pulmonary to systemic blood flow ratio in critical situations. PAB is also used to retrain the left ventricle in patients with transposition of the great arteries to prepare them for the arterial switch procedure, either following late presentation or following prior atrial repair. Another role played by PAB is to train the left ventricle in patients with congenitally corrected transposition of the great arteries, not only for the purpose of retraining the sub-pulmonary left ventricle but also as an early prophylactic approach in newborns to avoid the severe tricuspid regurgitation sometimes associated with a morphologic right ventricle in the systemic position. Currently, PAB has two indications: 1. to reduce the pulmonary blood flow and relieve the symptoms of congestive heart failure, and 2. to train the sub-pulmonary ventricle for future corrective surgery. Recently, PAB has been successfully employed to treat children with dilated cardiomyopathy (DCM), a disease that has shown considerably increased morbidity and mortality rates and indications for heart transplantation; some of the patients thus treated have shown improved left ventricular function, allowing them to be taken off the waiting list for heart transplantation. In this paper, we review the original and current indications for PAB and explain the surgical technique and strategy. We also present a literature review of the new indications for PAB in patients with pediatric DCM, and compare outcomes in Japan with those in other countries.