Catheter balloon adjustment of the pulmonary artery band: feasibility and safety.
The study aimed to assess the feasibility and safety of increasing pulmonary artery band (PAB) diameter by catheter-based PAB balloon dilation (PABBD). Eight dilations were performed between October 2006 and December 2008. Hemoclips were used to fix PABs surgically in a procedure designed to permit progressive clip dislodgment in a controlled manner. The PABBD resulted in gradual band loosening until the desired physiologic state was achieved. At time of PABBD, the patients had a mean age of 6 months (range 3-14 months) and a mean weight of 5 kg (range 2.6-7.3 kg). The median time from PAB placement until PABBD was 4.5 months (range 1-9 months). The single-balloon technique was used in seven cases (serial dilations in 5 cases) and the double-balloon technique in one case. The PABBDs were successful for all the patients, who experienced a mean saturation increase of 75-89% (P = 0.01) (mean increase of 20%), a mean PAB gradient decrease from 69 to 36 mmHg (P = 0.002) (mean decrease of 49%), and a mean band site diameter increase from 4.1 to 6.1 mm (P = 0.01) (mean increase of 45%). The only complication was transient pulmonary edema in one patient. The PABBD procedure is a feasible and safe method for increasing pulmonary blood flow in a staged manner and may eliminate the need for surgical band removal in some cases.
Department of Pediatric Cardiology, Rady Children's Hospital, University of California, San Diego, San Diego, CA, USA. hgelsaid@yahoo.com
Howaida
H
El-Said
Rabih
R
Hamzeh
John
J
Lamberti
John
J
Moore
D002404:Catheterization; D005240:Feasibility Studies; D005260:Female; D006330:Heart Defects, Congenital / Q000628:therapy*; D006801:Humans; D007223:Infant; D008297:Male; D011651:Pulmonary Artery; D012189:Retrospective Studies; D016896:Treatment Outcome