Pulmonary Artery Banding

Some heart defects, such as several holes between the ventricles or a single ventricle with no narrowing on its way to the lungs, send far too much blood to the lungs at high pressure. The baby struggles to breathe and grow, and over time the lung vessels can be damaged for good. Pulmonary artery banding, first reported in 1952, narrows the main pulmonary artery with a band so less blood and lower pressure reach the lungs. For years it was the usual first step for many such babies; now that most defects are repaired completely in infancy, it is kept for a few situations: many "Swiss-cheese" muscular VSDs, multiple VSDs with coarctation, a single ventricle with too much lung flow before a later Fontan, and to "train" the left ventricle before a late arterial switch. The band can be placed through a median sternotomy (now preferred by many surgeons, since it reaches the pulmonary artery easily even when the anatomy is unusual) or through a left thoracotomy. Bypass is not needed unless other work is done at the same time. The band, made of Teflon-impregnated Dacron, a PTFE strip or umbilical tape, is passed around the pulmonary artery without putting a clamp behind it, tightened while pressures and oxygen levels are measured, and stitched in place so it cannot slide. The main problems are a band that is too loose or too tight, a band that slides down and pinches a branch pulmonary artery, distortion of the pulmonary valve, and, rarely, erosion of the band into the artery. As the child grows, the band becomes relatively tighter. It is removed at the time of the full repair, often with a patch or a resection of the narrowed segment. For the scrub, this is a short case that depends on a loaded clip applier, the band material and a ready pressure line.