Ann Thorac Surg 2005;79:1463
© 2005 The Society of Thoracic Surgeons
Correspondence
Pulmonary Artery Banding Still Has an Important Role in the Treatment of Congenital Heart Disease
Naoki Yoshimura, MD,
Masahiro Yamaguchi, MD,
Shigeteru Oka, MD,
Masahiro Yoshida, MD,
Hirohisa Murakami, MD
Department of Cardiothoracic Surgery, Kobe Children's Hospital, 1-1-1, Takakura-dai, Suma-ku, Kobe 654-0081, Japan
yoshimura-cvs{at}umin.ac.jp
To the Editor:
We read with interest the article by Takayama and associates [1] concerning pulmonary artery (PA) banding. They followed 365 patients who underwent PA banding between 1966 and 2001. The early mortality rate in their series fell from 38.3% during the period 1966 through 1979 to 13.5% during the years 1980 through 1989. However, the mortality rate from 1990 into 2001 remained 13.8%, thus showing no improvement compared with the results in the 1980s. The authors wrote that early primary repair is the treatment of first choice for congenital cardiac defects and that PA banding now plays a smaller role and is indicated in fewer patients.
Between January 1980 and September 2003, 276 consecutive patients underwent PA banding in our hospital. They ranged in age from less than 1 day to 11 years (median age, 47 days), and body weight ranged from 0.86 to 43.6 kg (median weight, 3.2 kg). The primary anatomical diagnoses and the number of early deaths in each group are shown in Table 1 . The proportion of patients with coarctation or interruption of the aorta with ventricular septal defect, atrioventricular septal defect, and transposition of the great arteries or Taussig-Bing anomaly decreased in the latest period. On the other hand, the proportion of patients with single-ventricle physiology, who are candidates for a Fontan-type operation, increased. From 1980 through 1989 there were six early deaths; from 1990 through 1999, no early deaths; and from 2000 into 2003, one early death. Four patients died of low cardiac output syndrome. They were in shock and had metabolic acidosis preoperatively. Two patients with body weights of 1.4 kg and 1.6 kg died of respiratory distress. Another patient died of rupture of the pulmonary artery. Sixty-six patients (75.9%) in the earliest group underwent definitive repair at a mean interval of 3.4 years, and 116 patients (86.6%) in the second group had definitive repair at a mean interval of 3.3 years, Thirty-three patients (60.0%) in the latest group underwent definitive repair at a mean interval of 1.3 years, and 17 patients in this group are waiting for definitive repair.
With advances in pediatric cardiac surgery, operative indications have been extended to complex and high-risk patients. Although many neonates and infants are now treated by primary repair, medical problems such as sepsis, intracranial hemorrhage, low body weight, and associated noncardiac anomalies often preclude primary repair. Patients with complete atrioventricular septal defect associated with atrial isomerism or atrioventricular valve abnormality have usually been treated using a two-stage operation [2]. The majority of candidates for a Fontan type of operation initially receive a palliative surgical procedure [3]. In our study, the results of PA banding improved further in the 1990s. Currently, the number of patients who have PA banding are increasing in our hospital. We believe that PA banding can be performed safely and still has an important role in the treatment of congenital heart disease.
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References
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- Takayama H, Sekiguchi A, Chikada M, Noma M, Ishizawa A, Takamoto S. Mortality of pulmonary artery banding in the current era: recent mortality of PA banding. Ann Thorac Surg. 2002;74:1219–1224[Abstract/Free Full Text]
- Oshima Y, Yamaguchi M, Yoshimura N, Oka S, Ootaki Y. Anatomically corrective repair of complete atrioventricular septal defects and major cardiac anomalies. Ann Thorac Surg. 2001;72:424–429[Abstract/Free Full Text]
- Yoshimura N, Yamaguchi M, Oshima Y, et al. Risk factors influencing early and late mortality after total cavopulmonary connection. Eur J Cardiothorac Surg. 2001;20:598–602[Abstract/Free Full Text]
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