title: Pulmonary artery banding in infants and young children with left ventricular dilated cardiomyopathy: a novel therapeutic strategy before heart transplantation.
abstract: BACKGROUND
  Dilated cardiomyopathy (DCM) in childhood has a considerable morbidity and mortality and high incidence of heart transplantation. Pulmonary artery banding (PAB) has been proposed in patients with corrected transposition of the great arteries to retrain the sub-pulmonic left ventricle (LV) and to improve a failing sub-aortic right ventricle. We evaluated the short-term and medium-term effects of PAB in young patients with LVDCM.
  
  
  METHODS
  A retrospective single-center observational study was performed to evaluate the possible benefits of a dilatable surgical PAB in infants and young children with LVDCM.
  
  
  RESULTS
  Reported are 12 patients (10 infants, 2 toddlers) with LVDCM referred for heart transplant who received a surgical PAB. There were no hospital deaths. Clinical functional status improved in all patients. The pressure gradient across the PAB increased within 20 days from 28 ± 7 to 43 ± 15 mm Hg. The LV ejection fraction increased from 14.5% ± 5% pre-PAB to 27% ± 13% at hospital discharge and to 47% ± 10% at 3 to 6 months. The LV end-diastolic diameter (z-score) decreased (p > 0.001) from 46 ± 6.1 (+7.0 ± 1.3) to 35 ± 15 mm (+3.0 ± 1.3) after 3 to 6 months and to 34 ± 15 mm (+1.3 ± 1.14) after a median age of 2 years (maximum 6.6 years), respectively. Plasma B-type natriuretic peptide levels decreased from 3431 ± 2610 to 288 ± 321 pg/ml at discharge and to 102 ± 96 pg/ml 22 months later. Eight children were subsequently de-banded by transcatheter technique and 6 of them are currently at Ross Heart Failure Classification for Children class I. Two patients, both with non-compaction DCM, deteriorated at 5 and 6 months after PAB debanding and finally died.
  
  
  CONCLUSIONS
  In young children with LVDCM and still-preserved right ventricular function, PAB led to an improvement of LV and mitral valve function by ventricular interaction.
authors: Pediatric Heart Center, Justus-Liebig University Giessen, Germany. dietmar.schranz@paediat.med.uni-giessen.de
authors: Dietmar
authors: D
authors: Schranz
authors: Stefan
authors: S
authors: Rupp
authors: Matthias
authors: M
authors: Müller
authors: Dorle
authors: D
authors: Schmidt
authors: Anna
authors: A
authors: Bauer
authors: Klaus
authors: K
authors: Valeske
authors: Ina
authors: I
authors: Michel-Behnke
authors: Christian
authors: C
authors: Jux
authors: Christian
authors: C
authors: Apitz
authors: Josef
authors: J
authors: Thul
authors: Daphne
authors: D
authors: Hsu
authors: Hakan
authors: H
authors: Akintürk
mesh_terms: D000792:Angiography; D002311:Cardiomyopathy, Dilated / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D016027:Heart Transplantation; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*
chemical_list: D020097:Natriuretic Peptide, Brain