Pulmonary Artery Banding in Post-tricuspid Congenital Cardiac Shunting Defects with High Pulmonary Vascular Resistance
Reports of “treat and repair” of cardiac shunting lesions with inoperably high pulmonary vascular resistance (PVR) mostly concern pre-tricuspid defects; post-tricuspid lesions are different. We report our experience with pulmonary artery (PA) banding ± targeted pulmonary hypertension medications in five patients with a large VSD and inoperably high PVR, and review previous reports of PA banding with post-tricuspid defects. Three of our 5 patients had mean PAP > 50 mmHg after banding and no or only a transient fall in PVR. Two patients had mean PAP < 50 mmHg and lower PVR after banding; they had closure of their VSDs but have since had a progressive increase in PVR (follow-up after closure, 3.5 and 7.7 years). Previous reports have also documented difficulty in achieving sufficient band gradient. Of previously reported patients, only one became operable only after banding and targeted therapy, and was repaired; follow-up after repair was short-term (16 months). Our and previous experience demonstrate the difficulty in placing a PA band sufficiently tight to substantially reduce PA pressure. Reported attempts to “treat and repair” post-tricuspid defects are few and have met with limited success, and we found that PVR may increase significantly over time after repair. But more information is needed. Accurate interpretation of experience with “treat and repair” requires: careful characterization of the pulmonary circulation prior to “treating”; considering spontaneously reversible factors at pre-treatment catheterization before ascribing reduction in PVR to medical therapy; and long-term observation of PVR in patients who have had defect closure.
KeywordsVentricular septal defect Pulmonary hypertension Pulmonary artery band
We acknowledge the expert assistance of Lynne Patkin, MBA, in aiding with preparation of this manuscript.
Compliance with Ethical Standards
Conflict of interest
T.J. Kulik, J.E. McSweeney, J. Tella, and M.P. Mullen declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This limited case-series study meets criteria for waver by the Institutional Review Board of Boston Children’s Hospital.
- 6.Abman SH, Hansmann G, Archer SL, Ivy DD, Adatia I, Chung WK, Hanna BD, Rosenzweig EB, Raj JU, Cornfield D, Stenmark KR, Steinhorn R, Thebaud B, Fineman JR, Kuehne T, Feinstein JA, Friedberg MK, Earing M, Barst RJ, Keller RL, Kinsella JP, Mullen M, Deterding R, Kulik T, Mallory G, Humpl T, Wessel DL, American Heart Association Council on Cardiopulmonary CCP, Resuscitation, Council on Clinical C, Council on Cardiovascular Disease in the Y, Council on Cardiovascular R, Intervention, Council on Cardiovascular S, Anesthesia, the American Thoracic S (2015) Pediatric pulmonary hypertension: guidelines from the american heart association and american thoracic society. Circulation 132(21):2037–2099. https://doi.org/10.1161/CIR.0000000000000329
- 12.Mitropoulos FA, Apostolopoulou SC, Kanakis MA, Rammos S, Anagnostopoulos CE (2007) Bosentan treatment in an adult with pulmonary hypertension due to patent ductus arteriosus permits surgical repair. J Heart Lung Transplant 26(12):1345–1346. https://doi.org/10.1016/j.healun.2007.09.001 CrossRefPubMedGoogle Scholar
- 13.Ussia GP, Mule M, Caruso E, Aiello R, Tamburino C (2007) Combined endothelin receptor antagonist and transcatheter interventional therapy of patent ductus arteriosus with severe pulmonary artery hypertension. Int J Cardiol 116(3):427–429. https://doi.org/10.1016/j.ijcard.2006.03.080 CrossRefPubMedGoogle Scholar
- 14.Kameny RJ, Colglazier E, Nawaytou H, Moore P, Reddy VM, Teitel D, Fineman JR (2017) Pushing the envelope: a treat and repair strategy for patients with advanced pulmonary hypertension associated with congenital heart disease. Pulm Circ 7(3):747–751. https://doi.org/10.1177/2045893217726086 CrossRefPubMedPubMedCentralGoogle Scholar