Chronic and adjustable pulmonary artery banding.
OBJECTIVE
Banding of the pulmonary artery might be required to prevent pulmonary vascular damage in patients with increased pulmonary artery flow and to retrain the left ventricle in preparation for an arterial switch operation in patients with congenitally corrected transposition of the great arteries. Readjustment of the pulmonary artery band might be required in the postoperative period. In this study we aimed to test the feasibility of a novel device for bidirectionally adjustable pulmonary artery constriction.


METHODS
A hydraulic main pulmonary artery occluder was implanted in lambs and gradually inflated to create right ventricular pressure overload at a systemic (aortic) level. During the following period (up to 12 weeks), this pressure overload was monitored by measuring aortic and right ventricular pressures by means of implanted subcutaneous reservoirs. If required to maintain the right ventricular pressure overload at a systemic level in the growing animals, the occluder was deflated through a third subcutaneous reservoir.


RESULTS
After the banding period (average of 64 +/- 8 days), the main pulmonary artery cuff could still be adjusted, and the animals showed no clinical signs of heart failure. Histologic analysis of the pulmonary artery showed extensive fibrosis, a giant cell response around the device, and small areas of tissue necrosis; complete transmural necrosis was not detected.


CONCLUSIONS
This device allows adjustment of the pulmonary artery cuff in a precise manner over a prolonged period of time without surgical reintervention. Potentially, the device might have applications for clinical use in children with congenital heart disease.
Leeuwenburgh
Boudewijn P J
BP
Department of Pediatrics (Pediatric Cardiology), Leiden University Medical Center, Leiden, The Netherlands.
Schoof
Paul H
PH
Steendijk
Paul
P
Baan
Jan
J
Mooi
Wolter J
WJ
Helbing
Willem A
WA
D000818:Animals; D001011:Aorta; D001795:Blood Pressure Determination; D003250:Constriction; D004195:Disease Models, Animal; D005240:Feasibility Studies; D005355:Fibrosis; D005549:Foreign-Body Reaction / Q000209:etiology / Q000473:pathology; D015743:Giant Cells, Foreign-Body / Q000473:pathology; D006333:Heart Failure / Q000209:etiology / Q000517:prevention & control; D008026:Ligation / Q000009:adverse effects / Q000379:methods; D008422:Materials Testing; D008991:Monitoring, Physiologic; D011651:Pulmonary Artery / Q000473:pathology / Q000601:surgery* / Q000648:ultrastructure; D011652:Pulmonary Circulation; D012086:Reoperation; D012756:Sheep; D013997:Time Factors; D014188:Transposition of Great Vessels / Q000503:physiopathology / Q000601:surgery*; D017725:Ventricular Pressure