PERCUTANEOUSLY ADJUSTABLE PULMONARY-ARTERY BAND

Background. Pulmonary artery banding, originally introduced to palliat e increased pulmonary blood flow, is now primarily used for complex co ngenital cardiac defects with a prohibitive risk in the early repair, such as tricuspid atresia, or occasionally to prepare the left ventric le for eventual arterial switch. Conventional banding is, however, oft en poorly tolerated, and the precise adjustment required to reduce pul monary blood flow or sufficiently challenge the left ventricle is diff icult and can cause life-threatening hemodynamic changes. Methods. We designed a band that allows accurate tightening and is reversible duri ng the operation and at the bedside with the chest closed, allowing pr ecise gradual adjustment over days, thereby minimizing cardiovascular instability. This design is the extension of previous work done by one of us on an adjustable annuloplasty ring. Results. The band has been used for a 16-month-old child with tricuspid atresia type 1C who had u ndergone two failed attempts at banding. Hemodynamic measurements afte r 3 months confirmed achievement of the desired pulmonary pressure.Con clusions. This design, the simple insertion, and the ability to finely readjust the banding over days, combined with excellent patient toler ance, encourage further use of our adjustable band.