Abstract
Objectives: We evaluated the efficacy of balloon dilatation after bilateral pulmonary artery banding for the treatment of severe congenital heart disease that depends on patent ductus arteriosus for systemic circulation. Background: Neonatal cardiopulmonary bypass can cause brain injury, which may result in a severely impaired neurodevelopmental outcome. Hence, we perform bilateral pulmonary artery banding combined with postoperative percutaneous trans catheter angioplasty with balloon dilatation as first-stage palliation. Methods: From October 2007 to December 2013, 27 consecutive patients underwent bilateral pulmonary artery banding at our institution. We retrospectively obtained their diagnostic, clinical, and catheter examination data from the medical records. Results: Bilateral pulmonary artery banding was performed at a median of 7 days. Among the 27 patients, 16 underwent expansive angioplasty using a balloon catheter at each banding site to increase pulmonary blood flow. The mean age at dilatation was 53.4 ± 25.9 days, and the mean pulmonary artery index significantly increased from 130.6 mm2/m2 ± 51.1 mm2/m2 before dilatation to 243.6 mm2/ m2 ± 93.5 mm2/m2 after dilatation (p<0.01). All patients underwent a secondstage operation at a mean age of 126 ± 14.8 days. Of the 11 patients who did not undergo balloon dilatation, five required additional surgical interventions. However, of the 16 patients who underwent balloon dilatation, only one required an additional surgical intervention (p<0.01). Conclusions: Our strategy of balloon dilatation after bilateral pulmonary artery banding can improve the outcome of clinical treatment for severe congenital heart disease in infants. However, further studies are warranted.
Highlights
The surgical outcomes of hypoplastic left heart syndrome and its variants have improved in recent years, bilateral pulmonary artery banding is generally performed as a less invasive hybrid first-stage palliation in high-risk neonates [1,2]
Our strategy of balloon dilatation after bilateral pulmonary artery banding can improve the outcome of clinical treatment for severe congenital heart disease in infants
We aimed to evaluate the efficacy of balloon dilatation after bilateral pulmonary artery banding for the treatment of severe congenital heart disease that depends on patent ductus arteriosus for systemic circulation
Summary
The surgical outcomes of hypoplastic left heart syndrome and its variants have improved in recent years, bilateral pulmonary artery banding is generally performed as a less invasive hybrid first-stage palliation in high-risk neonates [1,2]. To avoid neonatal cardiopulmonary bypass, we perform a modified version of bilateral pulmonary artery banding combined with planned percutaneous pulmonary artery balloon dilatation at the banding sites approximately 1-2 months after banding [termed as flow-adjustable bilateral pulmonary artery banding (FABPAB)] as first-stage palliation for patients with severe ductus-dependent congenital heart disease, including hypoplastic left heart syndrome variants. Neonatal cardiopulmonary bypass can cause brain injury, which may result in a severely impaired neurodevelopmental outcome. We perform bilateral pulmonary artery banding combined with postoperative percutaneous trans catheter angioplasty with balloon dilatation as first-stage palliation
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