title: A novel adjustable pulmonary artery banding system for hypoplastic left heart syndrome.
abstract: OBJECTIVE
  Hypoplastic left heart syndrome remains a challenge for worldwide surgeons. Initial palliation employing bilateral pulmonary artery banding along with ductal stent implantation and atrial septostomy has been proposed as an alternative approach. However, the surgically placed bands are fixed and may become inadequate after sternum closure or with somatic growth of the patient. We describe the first case in which a neonate with hypoplastic left heart syndrome was initially managed using a mini banding system that allows for fine percutaneous adjustments of pulmonary blood flow.
  
  
  METHODS
  Through a mid sternotomy, a 5 day-old neonate underwent bilateral pulmonary artery banding using this new system combined with placement of a main pulmonary artery to innominate artery shunt.
  
  
  RESULTS
  The patient had an uneventful postoperative course. Three percutaneous adjustments of the banding system were necessary to keep the arterial oxygen saturation in the 75%-85% range. On the 48th day of life, she was submitted to stent placement (6 mm) within the atrial septum to treat a restrictive atrial septal defect. The Norwood operation and the bidirectional Glenn shunt were carried out on the 106th day of life. The bands were removed with no distortion of the pulmonary arteries.
  
  
  CONCLUSIONS
  The clinical use of this innovative pulmonary artery banding system was feasible, safe and effective. It allowed for customization of the pulmonary blood flow according to the underlying clinical needs, resulting in a more precise balance between the pulmonary and systemic circulations.
authors.affiliation: Hospital Samaritano de São Paulo. rsassad@cardiol.br
authors.forename: Renato Samy
authors.initials: RS
authors.lastname: Assadi
authors.forename: Marina M
authors.initials: MM
authors.lastname: Zamith
authors.forename: Maria Fernanda
authors.initials: MF
authors.lastname: Silva
authors.forename: Petrônio Generoso
authors.initials: PG
authors.lastname: Thomaz
authors.forename: Leonardo Augusto
authors.initials: LA
authors.lastname: Miana
authors.forename: Vitor Coimbra
authors.initials: VC
authors.lastname: Guerra
authors.forename: Carlos Augusto Cardoso
authors.initials: CA
authors.lastname: Pedra
authors.forename: Miguel
authors.initials: M
authors.lastname: Barbero-Marcial
mesh_terms: D013504:Cardiovascular Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000601:surgery*; D007231:Infant, Newborn; D010166:Palliative Care; D011184:Postoperative Period; D011651:Pulmonary Artery / Q000601:surgery*; D011652:Pulmonary Circulation / Q000502:physiology; D012039:Regional Blood Flow / Q000502:physiology; D015607:Stents; D013249:Sternum / Q000601:surgery