Pulmonary Artery Banding
Pulmonary artery banding (PAB) is a surgical procedure used to palliate certain congenital heart defects. Its main purpose is to limit excessive pulmonary blood flow, typically in cases where there are large left-to-right shunts causing overcirculation to the lungs. In the early days of congenital heart defect treatment, before routine definitive repairs were available, PAB was commonly the initial surgical intervention for children with specific heart abnormalities. The primary goal of PAB is to reduce pulmonary blood flow and safeguard the pulmonary vasculature from developing hypertrophy and irreversible pulmonary hypertension. By doing so, it helps prevent long-term damage to the lungs and prepares patients for future corrective surgery.
About Pulmonary Artery Banding
Pulmonary artery banding (PAB) is a palliative surgical procedure used to treat congenital heart defects characterized by excessive blood flow to the lungs, caused by left-to-right shunting. It is often performed on a specific group of newborns with complex congenital heart conditions to limit pulmonary circulation.
Historically, PAB was the first surgical intervention for newborns with heart abnormalities involving pulmonary overcirculation. However, over the past 20 years, early definitive intracardiac repair has largely replaced PAB. This shift occurred because many medical centers found that primary corrective surgery for neonates with congenital heart disease leads to better outcomes.
Types of Pulmonary Artery Bands
Pulmonary artery bands are designed to regulate blood flow and pressure to the lungs during heart surgeries. The different types include:
- Single Pulmonary Artery Band: A band placed around one pulmonary artery to reduce blood flow to one lung.
- Double Pulmonary Artery Band: This type wraps around both pulmonary arteries to evenly manage blood flow and pressure.
- Adjustable Pulmonary Artery Band: A band that can be tightened or loosened after placement to precisely control blood flow based on the patient’s needs.
These bands are used to manage congenital heart defects and improve overall heart function.
Benefits of Pulmonary Artery Bands
PAB offers several benefits, particularly for children with heart conditions:
- Improves Heart Function: By regulating blood flow to the lungs, PAB helps the heart work more efficiently, reducing strain.
- Manages Blood Pressure: It helps control pulmonary artery pressure, preventing damage to the heart and lungs.
- Delays or Avoids Complex Surgery: PAB can postpone or eliminate the need for more invasive surgeries, allowing time for the child to grow.
- Symptom Relief: It alleviates symptoms such as shortness of breath and fatigue by controlling blood flow.
- Supports Heart Development: For infants and young children, it helps the heart and lungs develop properly before more permanent repairs are made.
Risks of Pulmonary Artery Banding
While beneficial, PAB carries some risks:
- Infection: A risk associated with any surgical procedure.
- Bleeding: There is a possibility of excessive bleeding during or after the surgery, which may require further intervention.
- Band Migration: The band may shift from its original position, potentially necessitating another surgery.
- Heart Rhythm Issues: The procedure may cause irregular heartbeats, requiring monitoring.
- Pulmonary Complications: Lung-related issues, such as reduced lung function or fluid buildup, may arise.
- Growth Concerns: In children, the band could affect the normal growth of the heart and lungs, complicating future treatments.
Procedure of Pulmonary Artery Banding
PAB is typically performed through open-heart surgery, following these steps:
Anaesthesia and Incision: The procedure is carried out under general anaesthesia. The surgeon makes an incision in the chest to access the heart and pulmonary artery.
Placement of the Band: A band, usually made from biocompatible material like Dacron, is carefully placed around the pulmonary artery. The band is adjustable to allow precise control of blood flow.
Monitoring and Adjustment: The surgeon monitors the patient’s vital signs, adjusting the band during the procedure to achieve the right balance in blood flow and pressure.
Closure and Recovery: Once the band is securely positioned, the incision is closed with sutures or staples. The patient is then moved to the recovery room, where they are closely monitored for complications and given pain relief.
- Follow-up Care: Regular follow-up is crucial to assess the success of the procedure and the patient’s progress. Adjustments to the band may be needed over time, especially as the child grows. Further surgeries may be required to remove or modify the band to accommodate changes in the heart’s anatomy.