Intraoperative epicardial echocardiography in assessing pulmonary artery banding procedures.
BACKGROUND
Accurate perioperative assessment of the adequacy of pulmonary artery banding has hitherto relied on oximetry and direct pressure measurements. We report the use of epicardial Doppler echocardiography for assessing banding procedures.


METHODS
Six consecutive infants (3 male, 3 female; median age, 17 days) who underwent pulmonary artery banding for complex defects were studied by intraoperative epicardial Doppler echocardiography.


RESULTS
Excellent visualization of the relation of the band to the pulmonary valve and branch arteries was obtained, enabling or confirming optimal positioning. Doppler echocardiographic estimation of the pressure drop across the band was possible in each patient and resulted in further tightening of the band in 2 patients (33%) with satisfactory increases in transband pressure gradients. Intraoperative echocardiographic estimates of the transband gradients (median, 57 mm Hg; range, 52 to 71 mm Hg; mean +/- standard deviation, 59 +/- 7 mm Hg) correlated well with those obtained at subsequent transthoracic echocardiography (median gradient, 66 mm Hg; range, 52 to 67 mm Hg; mean +/- standard deviation, 63 +/- 6 mm Hg).


CONCLUSIONS
Epicardial echocardiography is a valuable adjunct to direct pressure and saturation measurements for adjustment of final band size and aids in confirming accurate band placement.
Sreeram
N
N
Heart Unit, Children's Hospital, Birmingham, England.
Jagtap
R
R
Silove
E D
ED
Brawn
W J
WJ
Sethia
B
B
D004452:Echocardiography; D005260:Female; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007432:Intraoperative Period; D008026:Ligation; D008297:Male; D011651:Pulmonary Artery / Q000601:surgery*