Percutaneously adjustable pulmonary artery band.

Abstract

Pulmonary artery banding, originally introduced to palliate increased pulmonary blood flow, is now primarily used for complex congenital cardiac defects with a prohibitive risk in the early repair, such as tricuspid atresia, or occasionally to prepare the left ventricle for eventual arterial switch. Conventional banding is, however, often poorly tolerated, and the precise adjustment required to reduced pulmonary blood flow or sufficiently challenge the left ventricle is difficult and can cause life-threatening hemodynamic changes. We designed a band that allows accurate tightening and is reversible during the operation and at the bedside with the chest closed, allowing precise gradual adjustment over days, thereby minimizing cardiovascular instability. This design is the extension of previous work done by one of us on an adjustable annuloplasty ring. The band has been used for a 16-month-old child with tricuspid atresia type 1C who had undergone two failed attempts at banding. Hemodynamic measurements after 3 months confirmed achievement of the desired pulmonary pressure. This design, the simple insertion, and the ability to finely readjust the banding over days, combined with excellent patient tolerance, encourage further use of our adjustable band.