What Is Pulmonary Artery Banding?

Pulmonary artery banding is suitable for: 1. Multiple ventricular septal defects that require incision of the left ventricle for repair. It is generally advisable to perform correction surgery at the age of 1 to 2 years. If congestive heart failure has occurred within 3 to 6 months, When using drug control, it is difficult to tolerate repair surgery. Consider palliative surgery first. 2. Ventricular septal defect infants with severe malnutrition or congestive heart failure and severe infections that cannot be controlled.

Pulmonary artery banding

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Pulmonary artery banding is suitable for: 1. Multiple ventricular septal defects that require incision of the left ventricle for repair. It is generally advisable to perform correction surgery at the age of 1 to 2 years. If congestive heart failure has occurred within 3 to 6 months, When using drug control, it is difficult to tolerate repair surgery. Consider palliative surgery first. 2. Ventricular septal defect infants with severe malnutrition or congestive heart failure and severe infections that cannot be controlled.

Pulmonary Artery Bundle Surgery; Pulmonary Artery Ligation; Pulmonary Artery Constriction; Pulmonary Artery Circulation

Cardiovascular surgery / ventricular septal defect surgery / pulmonary banding and band release

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Pulmonary artery banding was first proposed by Muller et al in 1952 as a palliative surgical method for treating large left-to-right shunts such as large ventricular septal defects. For some infants with large ventricular septal defects combined with severe pulmonary hypertension, it is difficult to tolerate intracardiac Looking directly at the surgeon, the application of pulmonary artery main band contraction can increase right ventricular pressure, reduce left-to-right shunts, and reduce the load on the left and right hearts to control congestive heart failure and prevent or prevent progressive changes in the pulmonary arterioles.

Pulmonary artery banding is suitable for:

1. Multiple ventricular septal defects require incision of the left ventricle for repair. It is generally advisable to perform correction surgery at the age of 1 to 2 years, if it has occurred within 3 to 6 months

1. Most of these children are critically ill, and cardiac diuresis and systemic supportive treatment must be strengthened before surgery.

2. Strengthen respiratory tract preparation and use effective antibiotics to prevent and control infection.

3. Newborns should pay attention to insulation and fluid balance.

General anesthesia, tracheal intubation, supine position, with a thin pillow in the left scapula.

1. The thoracothoracic approach is performed through the left and right outer 2nd or 3rd intercostal space. This incision can also be processed at the same time when the combined arterial duct is not closed or the aorta is narrowed. After the left pleural incision, the lungs were pulled outward and cut through the anterior longitudinal sacral nerve. The gap was revealed and a gap was separated between the ascending aorta and the main pulmonary artery. Right-angle forceps were used to pass through the transverse sinus and pass through the dissection. The aorta and pulmonary artery space are led out through the posterior wall of the pulmonary artery. The width of the belt is generally 6-8mm, and it has been confirmed that it surrounds the trunk of the pulmonary artery.

Release the traction on the left lung to re-expand the lungs, and then hyperventilate for a few minutes before revealing the pulmonary artery trunk.

2. For premature babies and some small and malnourished babies, it is recommended to choose the outer diameter of the left anterior 2nd intercostal space pleura, use a small retractor to retract the intercostal space to push the pleura outward, and sometimes the left lobes of the thymus are removed to help reveal . Cut the heart pack to reveal the pulmonary artery trunk and open arterial catheter. Pulmonary artery trunking method is the same as above. Make a purse suture on the pulmonary artery trunk around the distal end of the band, and insert the pressure measuring needle into the pulmonary artery trunk.

3. The degree of narrowing of the main pulmonary artery bundle can refer to the following indicators: Reduce the distal pulmonary artery systolic blood pressure to the normal range, that is, 30mmHg; Another indicator is determined according to the change of systemic blood pressure, and with the tightening of the distal pulmonary artery pressure by the belt The systemic pressure starts to rise. When the systemic pressure reaches the plateau, it is appropriate, otherwise it will increase the extra burden on the ventricle and become intolerable. Reduce the pulmonary artery trunk to 1/3 1/2 of the original diameter. Make the pressure difference between right ventricle and pulmonary artery reach 50mmHg; Reduce pulmonary artery pressure to 50% of systemic pressure.

4. When the girdle is contracted to an appropriate level, immediately tighten the knot and firmly fix the narrowed band on the main pulmonary artery.

5. Remove the pressure needle on the pulmonary artery, ligate the preset poacher, completely stop bleeding, and close the pericardial incision.

1. The central venous pressure tube and arterial pressure tube should be placed before the pulmonary artery banding operation to monitor the arterial pressure and evaluate the effect of band shrinkage.

2. If the systemic circulation pressure is too low at the beginning of the operation, catecholamines can be intravenously infused, because it is difficult to accurately estimate the appropriate degree of narrowing of the pulmonary artery under low cardiac output.

3. In the case of malnourished babies after successful pulmonary constriction surgery,

1. A band cut through the pulmonary artery causes fatal massive bleeding.

2. The pulmonary artery band can slide to the distal pulmonary artery bifurcation, causing distortion or stenosis on one or both sides of the pulmonary artery.

3. If the pulmonary artery bundle is not narrow enough, pulmonary vascular obstructive disease can still occur.

4. Obstruction of left ventricular outflow tract obstruction after narrowing of pulmonary artery bundle.

5. Infants and young children grow quickly after surgery and find that the bands become too tight, and radical surgery is needed as soon as possible.