TRIAL OF PULMONARY-ARTERY BANDING - A DIAGNOSTIC CRITERION FOR ONE-STAGE ARTERIAL SWITCH IN SIMPLE TRANSPOSITION OF THE GREAT-ARTERIES BEYOND THE NEONATAL-PERIOD

Objective: Arterial switch operation (ASO) is the procedure of choice for the repair of simple d-transposition of the great arteries (TGA) d uring the neonatal period. Beyond this time such correction is perform ed in two stages. The first step incorporates banding of the pulmonary artery with or without a Blalock-Taussig shunt to train the left vent ricle (LV). The second step consists of the ASO. To find out whether c andidates for a two-stage procedure would tolerate a one-stage correct ion, a trial of pulmonary artery banding was performed. Material and m ethods: Between February 1986 and December 1995, 224 patients less tha n 3 months of age with TGA, intact ventricular septum or a small restr ictive ventricular septal defect, had an ASO. Seven patients were 4 we eks of age or older (28-70 days). Two of these had a pulmonary artery to systemic pressure ratio higher than 0.6 and underwent primary ASO w ithout complications. The remaining five patients had low left ventric ular pressure with a pulmonary to systemic pressure ratio of 0.2-0.5; echocardiography showed a banana-shaped LV with left ventricular wall thickness as low as 3 mm. They underwent a trial of pulmonary artery b anding to systemic pressure for 15-30 min, As this increase in workloa d was tolerated well with an anticipated decrease of oxygen saturation but without hemodynamic disturbances anticipated, the ASO was perform ed immediately. Results: Postoperative course was uneventful in all fi ve patients, although catecholamine dependence was prolonged and three patients received enoximone. There were no seven complications. Echoc ardiography showed an increase in posterior wall thickness from 3 to 6 mm after 19 days in one infant. Conclusion: Some of the children, ass igned for a 'two-stage' ASO may tolerate a primary anatomic repair up to an age of at least three months. This subgroup can be selected by a trial of pulmonary artery banding. Copyright (C) 1997 Elsevier Scienc e B.V.