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| Precise Evaluation of Bilateral Pulmonary Artery Banding for Initial Palliation for High-Risk Hypoplastic Left Heart Syndrome |
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Kazuo Kitahori1, Arata Murakami1, Tetsuhiro Takaoka1, Shinichi Takamoto2, Minoru Ono1; 1Cardiothoracic Surgery, The University of Tokyo, Hospital, Tokyo, Japan; 2Cardiothoracic Surgery, Mitsui Memorial Hospital, Tokyo, Japan Objective: In patients with high-risk hypoplastic left heart syndrome (HLHS), the Norwood operation (NW) in the neonatal period still has a high mortality compared with other cardiac surgery, so bilateral pulmonary artery banding (bPAB), a very effective initial operation for HLHS, was performed, but precise evaluation of bPAB has not been done sufficiently. We present our findings here. Methods: We have performed bPAB since 2006. Seventeen patients with HLHS or a variant underwent bPAB before NW. Echocardiography was performed between bPAB and NW, and the flow acceleration just after bPAB and before NW was evaluated. Before NW, a catheter examination was also performed. Results: The bPAB was performed at 6.6±0.6 days of age, and NW, at 130±88 days. Body weight (BW) was 2.5±0.4 kg at bPAB and 4.0±1.1 kg at NW. The length of the tape for bPAB was 9.9±0.6 mm in the right PA (RPA) and 9.4±0.6 mm in the left PA (LPA) because RPA was usually wider than LPA. The width of the tape was 2 mm in all cases. Catheter examination was performed at 95±85 days after bPAB. SaO2 was 71±8.6%. Multi-regression analysis revealed that SaO2 was estimated well by 4 factors; banding size of RPA, BW at BPAB, BW at NW and period between bPAB and catheter examination (R2=0.79). The echocardiography just after bPAB showed the blood flow at bPAB was accelerated to 3.0±0.8 m/s in RPA and 3.3±0.8 m/s in LPA. The estimated pressure gradient was 39.2±17.6 mmHg in RPA and 46.1±23.0 mmHg in LPA. The blood flow at bPAB was accelerated to 3.7±0.7 m/s in RPA and 4.0±0.6 m/s in LPA before NW. The estimated pressure gradient was 62.6±27.6 mmHg in RPA and 56.1±19.6 mmHg in LPA before NW. Catheter examination revealed mean wedge pressures of 18.0±7.2 mmHg for RPA and 16.2±4.3 mmHg for LPA. Operative mortality was zero. One patient needed reoperation to adjust PAB. Prolonged pleural effusion was observed in 1 case. Conclusion: Post operative SaO2 after bPAB correlated closely with banding size, BW at PAB and NW and period after bPAB. Since the mean PA pressure before NW was low enough for single ventricular circulation, the bPAB in this study was an effective option for high-risk patents with HLHS or a variant. We consider that our size of bPAB was suitable; BW+7 mm in LPA and BW+7.5 mm in RPA. Back to 2010 Annual Meeting Back to Program Outline Back to Main Program |
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